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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 18  |  Issue : 1  |  Page : 42-45

Reasons and pattern of teeth extraction in a maxillofacial clinic in Northern Nigeria


1 Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
2 Department of Dental and Maxillofacial, Jos University Teaching Hospital, Jos, Nigeria
3 Dental Department, University of Calabar Teaching Hospital, Calabar, Nigeria
4 Dental Surgery Department, Faculty of Clinical Sciences, Ahmadu Bello University, Zaria, Nigeria
5 Department of Maxillofacial Surgery, Ahmadu Bello University, Zaria, Nigeria

Date of Submission01-Jan-2021
Date of Decision07-Jan-2021
Date of Acceptance27-Jan-2021
Date of Web Publication4-May-2021

Correspondence Address:
Dr. Benjamin Fomete
Department of Maxillofacial Surgery, Ahmadu Bello University Teaching Hospital, Zaria
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njbcs.njbcs_1_21

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  Abstract 


Context: Exodontia or teeth extraction make up the majority of workload in the minor surgery of most oral and maxillofacial surgery clinics in our environment. Extraction of teeth represents different percentages amongst children and adult populations and private and public clinics, respectively, also. Aims: The aim of this study was to determine the indications for and pattern of teeth extraction in patients presenting at the maxillofacial surgery clinic. Settings and Design: Records of patients who had teeth extractions at the Oral and Maxillofacial Surgery Clinic between 1st January 2006 and 31st December 2018 were retrieved and retrospectively studied from the Medical Records and the Minor Surgery register book. Methods and Materials: The biodata and indications for extraction were recorded. Results: A total of 1220 records from the year 2006 to 2018 were used to conduct the research. They comprised 636 (52.1%) males and 584 (47.9%) females. Their age range was 2 years to 92 years with a mean age of 31.8 ± 14.6. The most predominant age group that attended clinic for extraction was the 20–29 years of age accounting for 35.6% of the study participants with more males 228 (52.3) than the females 208 (47.7). Conclusion: Dental caries and its sequelae continue to be the leading cause of tooth extraction in our environment, followed by tooth impaction as well as pericoronitis around impacted teeth.

Keywords: Dental caries, pattern, sequelae, tooth extraction


How to cite this article:
Fomete B, Agbara R, Nzomiwu LC, Agho TE, Baraya ZG. Reasons and pattern of teeth extraction in a maxillofacial clinic in Northern Nigeria. Niger J Basic Clin Sci 2021;18:42-5

How to cite this URL:
Fomete B, Agbara R, Nzomiwu LC, Agho TE, Baraya ZG. Reasons and pattern of teeth extraction in a maxillofacial clinic in Northern Nigeria. Niger J Basic Clin Sci [serial online] 2021 [cited 2021 Jun 23];18:42-5. Available from: https://www.njbcs.net/text.asp?2021/18/1/42/315403




  Introduction Top


Patients could seek dental services for pain, bleeding, tooth mobility and poor appearances amongst others. They expect that the available treatment will meet their needs and demand.[1]

Exodontia or teeth extraction make up the majority of workload in the minor surgery in most oral and maxillofacial surgery clinics in our environment.[2] Extraction represented about 58.8% and 33.4% amongst children[3] and adult[4] populations, respectively, in Nigeria. With respect to public and private sectors, it was between 25.4 and 21.4%, respectively, in Kenya.[5],[6]

Although the reasons/indications for teeth extraction vary from one country to another, some of them are common to all such as caries and periodontal diseases (PD).[2] Studies[2],[3],[7] on reasons for extraction have been carried out in Nigeria, but to the best of our knowledge, very few has been conducted in the North West Geopolitical zone and none has been conducted in our centre, knowing that oral health indices varies according to geographical locations, culture, socioeconomic class, beliefs, oral health knowledge and behaviour as well as utilisation of dental services, report of this study will help to compare results and inform decisions that may change oral health narratives across tribes and zones in Nigeria as a result of these variations.

The aim of this study therefore was to determine the indications for and pattern of tooth extraction amongst individuals treated in an oral and maxillofacial surgery clinic in the Northwest Nigeria.


  Patients and Methods Top


Records of patients who had tooth extractions at the Oral and Maxillofacial Surgery Clinic of a tertiary health facility between 1st January 2006 and 31st December 2018 were retrieved retrospectively studied from the Medical Records and the Minor Surgery register book. Information including age, gender, reason for tooth extraction and type of tooth extracted were retrieved, collected and analysed. The indications for extraction were categorised into dental caries (DC), pulp infections, periapical periodontitis (PP), PD, facial space infections, impaction/pericoronitis, retained primary teeth, traumatic dental injuries (TDI) and others. Data were analysed using Statistical Package for the Social Sciences version 22.0 (Illinois, USA) was used for the analysis, and P < 0.05 was considered statistically significant.

Included in the studies were all patients whose records were complete and those without complete records were excluded from the study.

Approval for the study was obtained from the hospital Ethics Committee (ABUTH/HREC/W37/2020).


  Results Top


A total of 1220 records from the year 2006 to 2018 were used to conduct the research. They comprised 636 (52.1%) males and 584 (47.9%) females. Their age range was 2 years to 92 years, with a mean age of 31.8 ± 14.6 [Table 1]. In the total distribution of teeth extracted by age and gender, this study showed that male within the 21–30 years age group had more extractions than others. From [Table 1], 636 (52.1%) of the respondents were males, while 584 (47.9%) of the respondents were females.
Table 1: Relationship between the age groups and gender of patients who had teeth extraction

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The most predominant age group that attended clinic for extraction was the 20–29 age group accounting for 35.6% of the study participants with more males 228 (52.3) than the females 208 (47.7).

As shown in [Table 2], the most common reason for extraction of teeth was PP 411 (33.7%) followed by impaction/pericoronitis of mandibular wisdom tooth 189 (15.5%) the least were grouped as others, which included ectopic eruption, cystic lesions, failed restorations.
Table 2: Indications for extraction amongst the patients

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The total number of teeth extracted was 1385, while the most frequently extracted tooth was the left mandibular wisdom tooth 165 (12.1%), followed by the right mandibular third molar 147 (10.6%). The females had more of their wisdom teeth extracted than the males and this was statistically significant (P = 0.001).

In the primary dentition, extraction of the second molar was most frequent and that the extraction of right was more common than that left.

There was a significant relationship between age, gender and reasons for extraction (P = 0.001), with the 20–29-year age group having more extractions than the other groups and males having more extractions than the females. Other reasons for extractions were ectopic tooth eruptions, cystic lesions, failed restoration, etc. The [Table 3] shows the distribution of 1220 respondents based on gender and [Table 4] based on the age all in relation to the indications for extraction.
Table 3: Distribution of the indications for extraction according to gender of patients

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Table 4: The indications for extraction according to age groups of patients

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  Discussion Top


This study assessed 1220 records of individuals that had extraction over a 13-year period in a tertiary institution in North Western geographical zone of Nigeria. In this study, there was no true sex predilection, the males-to-females (male: female) ratio being 1.1:1. This is similar to a study in Kano,[8] the United Arab Emirates (UAE)[9] and Saudi Arabia[10] where more males had extraction but differs from the result of other Nigerian studies in Benin,[2],[4] Eastern Nigeria,[11] and Sokoto[12] where the females had more extractions than the males. The male preponderance in our study could be explained to be that females have better health-seeking behaviour, frequently seek dental treatment earlier and therefore would have received dental treatment and hence would have less frequency of tooth extractions than their male counterpart.

In this study also, the age group of 20–29 years was the most predominant group accounting for about 35.6% of the total study population. Reports of several studies[8],[11],[12] are similar to these findings; however, a study in the UAE[9] reported that more significant teeth extractions were done at the age between 30 and 49 years old in their own study.

PP, a sequela of DC, was the most common reason for extraction in this study. In all age groups except 91–99 years, more teeth were extracted as a result of caries than as a result of PD, which is in agreement with studies in Ife and Benin.[2],[13] DC and its sequelae have been found to be the predominant reason for extraction amongst different study participants in most countries.[2],[7],[9],[13],[14],[15] The high proportion of individuals who extracted their teeth due to PP showed that participants presented late at the hospital with complicated DC. This could be as a result of ignorance from poor dental education or lack of financial support as treatment is usually out of pocket payment.

Forceps extraction technic constituted the bulk of extraction in this study, followed by surgical (transalveolar) extraction (15. 5%). This was by far >1.0% and 4.1% in both Benin City and Ife, respectively.[2],[13] Reason for this difference could be that the centre has remained a purely maxillofacial centre where most cases of surgical extraction are referred to. In addition, impaction of third molar/recurrent pericoronitis was the 2nd most common reason for extraction in this centre. Surgical extractions are associated with higher morbidity due to longer time taken for the extraction.[16]

Saheeb and Sede[2] observed that the age group of >51 years had more teeth extracted as a result of PD than the age group of <50 years. This disagrees with the observation in this study where DC and its sequelae still dominated in persons above 50 years. Rather it was observed, that amongst those who had teeth extraction as a result of PD, the 20–29 years and 30–39 years age groups were more predominant.

This study, however, shows a slight predominance of female gender for extractions due to PD. This contrasts the report of Saheeb and Sede,[2] which did not show any remarkable difference between the genders.

This study found that the left mandibular third molar teeth were the most extracted. This is similar to the findings of Taiwo et al.[12] in a study amongst adult patients in Sokoto Nigeria. Several studies[2],[17],[18] also reported that the most extracted teeth were the molar teeth. This has been attributed to their morphology, time of eruption and positioning of tooth in the oral cavity which predisposes them to decay and loss.[19] In our study, the mandibular molars were the most extracted, which agrees with Taiwo et al.[7] and Saheeb and Sede[2] but disagreed with the findings of Thomas and Al-Maqdassy,[17] who found the maxillary molars the most extracted teeth. Saheeb and Sede[2] attributed the loss of molar teeth to their early eruption, deep fissures, lack of accessibility to proper brushing and to the fact that they are more commonly used for mastication hence, their early exposure to caries and loss.

The females in this study had more of their third molars extracted than the males. This finding is similar to that reported by Obuekwe and Enabulele[20] where higher frequency of impacted teeth was seen in females. However, there are other studies that reported no gender difference[16] and male preponderance.[21] This has been attributed to differences in growth pattern between males and females with the females having less incremental growth and a shortened duration of growth for the mandible compared to the males.[22]

TDI accounted for 8.3% of the reasons for extraction amongst the study population. This proportion is similar to that reported by Taiwo but about twice the figure reported by Saheeb and Sede.[2] It was observed that a higher proportion of adolescent in this study extracted their teeth due to TDI and as reported in other studies TDI affected more of the younger participants such that about 77% of those that had trauma were <30 years. This could also be explained by the increasing rate of road traffic accident, and the increased rate of violence in the northern region of Nigeria in recent years.

With regard to the extracted primary teeth, the mandibular second molars were the most frequently extracted teeth. This is in agreement with the study carried out amongst children aged 0–16 years in Benin city, Nigeria.[14] This may be because the second primary molar is the most posterior of all the primary teeth making it difficult for children to clean. In addition, amongst all the primary teeth, it remains in the mouth for the longest period of time before exfoliation. However, this finding contrasts the report from another tertiary center in the South-South region where primary anterior teeth were the most frequently extracted.[23]

Nearly, 129 (10%) of the total extraction was primary teeth. Some of the extractions could have been prevented if the study centre had a paediatric dental unit and an orthodontic unit to provide the appropriate dental needs of the children and adolescents. For example, some of the extracted teeth would have undergone pulp therapy with stainless steel crown while some teeth with malocclusion would have undergone orthodontic therapy.


  Conclusion Top


DC and its sequelae continue to be the leading cause of tooth extraction in our environment, followed by impaction/pericoronitis. Patients should not be denied access to specialist's care so as to improve their quality of life. This trend calls for revisiting of the preventive measures of caries in our environment at all age groups, especially the younger ones.

This study being a retrospective has some limitations such as complications not being documented, difficult extraction amongst others.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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