|Year : 2018 | Volume
| Issue : 3 | Page : 80-83
Prevalence and distribution of tooth wear in an elderly cohort in Port Harcourt, Nigeria
Omoigberai Bashiru Braimoh, Grace Onyenashia Alade
Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
|Date of Web Publication||19-Nov-2018|
Omoigberai Bashiru Braimoh
Department of Preventive Dentistry, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Choba Port Harcourt, Rivers State
Source of Support: None, Conflict of Interest: None
Background: The retention of natural teeth and tooth wear is observed to be increasing among old people. Consequently, tooth wear may become a major dental problem among old people. Therefore, the purpose of this study was to determine the prevalence and distribution of tooth wear among the elderly in Port Harcourt, Rivers State, Nigeria. Subjects and Methods: The study was an observational research design among the elderly population in Port Harcourt, Rivers State. The subjects were selected by systematic random sampling and data collected using pilot-tested questionnaire. Tooth wear was recorded using tooth wear index, of Smith and Knight. Data were analyzed using Statistical Package for Social Sciences version 20. Chi-square analysis was used to test association between variables, and statistical significance inferred at P < 0.05 at 95% confidence interval. Results: The prevalence of tooth wear among the study participants was 83.2%. Approximately 40% had mild tooth wear and 177 had moderate tooth wear. Severe tooth wear was seen in 7.2% of the respondents. Attrition was observed in 10,362 (76.3%) teeth examined. Tooth wear significantly occurred in the mandible than the maxilla (P = 0.023). The prevalence of tooth wear was 38.0%, 28.4%, 19.9%, and 13.7% for the molar, premolar, incisors, and canine, respectively, in the maxilla and mandible combined. Conclusion: The results of this study compare with the findings of other Nigerian studies in a similar population. However, when compared to other studies in similar population from Western cultures and China, the observed pattern of tooth wear was different. Therefore, there is a need to develop appropriate local measures for the prevention of tooth wear lesions.
Keywords: Elderly population, Nigeria, prevalence, tooth wear, tooth wear index
|How to cite this article:|
Braimoh OB, Alade GO. Prevalence and distribution of tooth wear in an elderly cohort in Port Harcourt, Nigeria. J Dent Res Rev 2018;5:80-3
|How to cite this URL:|
Braimoh OB, Alade GO. Prevalence and distribution of tooth wear in an elderly cohort in Port Harcourt, Nigeria. J Dent Res Rev [serial online] 2018 [cited 2018 Dec 16];5:80-3. Available from: http://www.jdrr.org/text.asp?2018/5/3/80/245678
| Introduction|| |
Tooth wear constitutes a public health problem and impact on the quality of life and well-being of the affected individuals. Tooth wear with loss of the enamel and dentin causes damage to the oral health with resultant dentin hypersensitivity, pulpitis, periapical periodontitis, and pulp necrosis. Tooth wear can be classified as attrition, erosion, and abrasion. Attrition is the loss of tooth substance due to tooth-to-tooth contact. Abrasion, on the other hand, is defined as the loss of tooth substance by mechanical means other than tooth contact. Erosion is the loss of dental hard tissues by chemical action without the involvement of bacteria.
The prevalence of tooth wear lesions is variable, and studies have shown that it varies according to age, gender, occupational groups, geographic areas, and cultures.,, Tooth wear is reported to be higher among males than females in communities with similar social and demographic factors.,
There are a number of quantitative and qualitative methods for assessing tooth wear. In this study, the tooth wear index (TWI) introduced by Smith and Knight was used. The TWI is a more general concept for measuring tooth wear irrespective of the cause. The index evaluates tooth wear on the cervical, buccal, lingual, and occlusal–incisal surfaces of the mandibular teeth and cervical, buccal, palatal, and occlusal–incisal of the maxillary teeth. The index is reproducible and simple to use.
Globally, the proportion of individuals aged 60 years and above is expected to increase in three folds; this population group is expected to increase from 810 million in 2012 to 2.03 billion by 2050., This growth in population is immense and would pose great challenges in caring for the aging population. Globally, tooth wear is more common in the elderly and is considered as an ever-increasing problem particularly in this group. Therefore, considering the increasing elderly population and elderly edentulous becoming less common, tooth wear may become dental problem of great importance in this group.
According to Van't Spijker et al. most data on the prevalence of tooth wear are reports on children and adolescents with relatively few studies conducted on adults and elderly. This may be due to the difficulty of recruiting the elderly for representative samples on the prevalence of tooth wear. The situation is not different in Nigeria, studies which investigate tooth wear among the elderly in Nigeria are uncommon. Therefore, the objective of this study was to determine the prevalence and distribution of tooth wear among the elderly in Port Harcourt, Rivers State, Nigeria. The study would enable dentists to have an understanding of the epidemiological status of tooth wear among elderly in Port Harcourt, develop preventive strategies and improve on the clinical management of tooth wear in this age group.
| Subjects and Methods|| |
The study was an observational research design, and the population of the study were pensioners 60 years and above in Port Harcourt, Rivers State. Pensioners were recruited for this study as a representative sample of the elderly to overcome the problem of recruiting elderly from the general population. A minimum sample size of 383 was estimated to be adequate. The assumptions made were: The prevalence of tooth wear in an adult population of 53%, precision (d) 5% and confidence interval of 95%. Although the calculated minimum sample size was 383, a total of 543 elderly participants were involved in the study.
The participants were selected by systematic random sampling where every second subject was selected from the register of the pensioners. Selected subjects who were absent in a particular visit were contacted through their phone numbers to be present for subsequent visit.
Data were collected by the use of questionnaire. A section of the questionnaire contained information on gender, age, and educational status. Tooth wear was recorded in another section of the questionnaire according to TWI of TWI of Smith and Knight was used. The severity of tooth wear was scored on a nominal scale of 0–4: Score 0: sound tooth with no loss of enamel surface characteristics and no change in contour on cervical region, Score 1: loss of enamel surface characteristics and minimal loss of contour on C cervical region, Score 2: loss of enamel exposing the dentine for <1/3 of the surface and defect <1 mm deep on cervical region, Score 3: loss of enamel exposing the dentine for more than one-third of the surface on and defect 1–2 mm deep on cervical region, and Score 4: complete loss of enamel or pulp exposure on and defect more than 2 mm deep on cervical region. Loss of tooth substance on the occlusal or incisal surface was recorded as attrition, on the buccal surface and cervical region as abrasion and on the lingual surface as erosion. The oral examination was carried out at the secretariat of the pensioners using gloves, wooden spatulas and dental probes under natural light. Cotton wool rolls were used to dry the teeth surfaces to enhance visibility. All the teeth in the mouth were examined; however, impacted third molar, teeth with extensive accumulation of calculus, fluorosed and hypoplastic teeth, teeth with any form of restoration, fractured, and carious teeth were excluded.
The reliability of the instrument was done using old people from location different from where the present research was conducted. This also served as the pilot-test for this study. A total of 20 of old persons completed the questionnaire and were examined by the researcher 1 week apart. The examination was done by the first author and the intra-examiner reliability for the recording of tooth wear determined by intra-class correlation was 0.81. This study was conducted over a period of 2 years from April 2015 to March 2017.
Informed consent was sought from the participant before data collection, and the research protocol for this study was approved by University of Port Harcourt Research Ethics Committee. Individuals who retired voluntarily from the Rivers State government public service or retired having put in 35 years of years of service and were below the age of 60 years were excluded from the study.
The 543 copies of the questionnaire administered to the respondents were all retrieved and found usable. The completed copies of the questionnaires were sorted out and entered into the Statistical Package for Social Sciences (IBM SPSS Armonk, New York, USA) spreadsheet version 20 for analysis. Descriptive statistics of frequency and percentage was used to present the results. Based on the TWI score, tooth wear was categorized into sound teeth (score 0), mild tooth wear (Score 1), moderate tooth wear (Score 2), and severe tooth wear (Score 3 and 4). Chi-square analysis was used to test association between variables. Significance was determined at 95% confidence interval, and statistical significance inferred at P < 0.05.
| Results|| |
All the questionnaires administered were retrieved and found usable giving a response rate. Of the 543 participants, 295 (54.3%) were males and 248 (45.7%) were females. The age of the participants ranged from 60 years to 82 years with a mean of 67.6 years. Most of the respondents 234 (43.1%) were 60–64 years old. Regarding educational status, 226 (41.6%), 198 (36.5%), and 119 (21.9%) of the participants had tertiary, secondary, and primary education, respectively.
The prevalence of tooth wear among the study participants was 83.2% (452). Approximately 40% (216) had mild tooth wear and 177 (32.6%) had moderate tooth wear. Severe tooth wear was seen in 39 (7.2%) of the respondents [Table 1].
[Table 2] shows the type of tooth wear lesions recorded among the respondents. Attrition was observed in 10,362 (76.3%) teeth examined. A total of 1708 teeth (12.6%) and 614 teeth (4.5%) respectively showed abrasion and erosion.
|Table 2: Distribution of type of tooth wear lesions among the participants|
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A total of 13,581 teeth were assessed for tooth wear and the mean number of teeth examined per individual was 25.0. A total of 3795 teeth were excluded, of the 3795 excluded, 3177 teeth were decayed or missing as a result of dental caries and 618 were excluded for other reasons. Regarding the jaws, tooth wear significantly occurred in the mandible than the maxilla (P = 0.023). Considering the type of teeth, in the maxilla and mandible combined, the prevalence of tooth wear was 38.0%, 28.4%, 19.9%, and 13.7% for the molar, incisors, premolar, and canine, respectively. The order was the same when the maxilla and mandible were considered independently [Table 3].
| Discussion|| |
The retention of natural teeth and prevalence of tooth wear is observed to be increasing in the elderly population. Consequently, tooth wear may become dental problem of great importance among the old people. Tooth wear lesions result in the loss of the enamel and dentin causing dentin hypersensitivity, pulpitis, periapical periodontitis, and pulp necrosis. Therefore, a clear understanding of this condition is imperative to increase awareness and provide preventive and comprehensive management of tooth wear in the elderly and the general population.
The prevalence of tooth wear recorded in this study was 83.2%; although the prevalence is considered high, it is low when compared to 92.8% reported among old people in Ibadan, Nigeria. The difference in age of the study population may account for this difference. The age of the study population in the previous study conducted in Ibadan was 65 years and above, in the present study, this was 60 years and above. Studies have reported increase in tooth wear with an increase in age. However, other population characteristics such as gender, oral habits, educational status, occupation, geographic areas, and cultures may also play a role in tooth wear lesions.,, Again the prevalence recorded in the present study was higher than 53% recorded in another study in Ibadan among 20–64 years old and 55.3% among 16–66 years old in Benin City, Nigeria. This further supports age as a predictor of tooth wear lesions.
Regarding the grading of tooth wear, the prevalence data in the present study show that mild and moderate tooth wear is a common condition in the elderly population in Port Harcourt Nigeria; in contrast to severe and extreme tooth wear which are uncommon. Taiwo et al. reported similar findings among elderly population in South East Ibadan, Nigeria. The findings of Wetselaar et al. and Daly et al. among Dutch and Malaysian adult population respectively are also in agreement with the present study.
Considering the type of tooth wear, in a study to assess the patterns of tooth wear and their associated etiologies in an adult population in Kelantan, Malaysia, abrasion was found to be the most common form of tooth wear. In Western Europe, erosion is the most common form of tooth wear,, this is attributed to increase consumption of acidic drinks and food. A number of studies have reported attrition as the most common type of tooth wear among Nigerians.,,, In the present study, attrition was observed as the most predominant form of the tooth wear lesion; this is in line with other Nigerian studies.,,, The high fibrous diet, chewing, and crushing of bones with heavy masticatory force and the use of chewing sticks for routine oral hygiene care have been reported to be responsible for the preponderance of attrition among Nigerians., The coarseness or grit of the diet during function is also the main causative factor in occlusal wear. The prevalence of attrition recorded in this study was 76.3%, this is lower than 89.6% reported among the elderly in Ibadan. This variation may be attributed to the difference in statistical methods used to determine attrition in both studies. In the present study, the prevalence of attrition was determined based on the total number of teeth examined in the study participants unlike the previous study in which attrition was determined based on number of persons with attrition, this may overestimate the prevalence.
There is variation in the level of tooth wear observed in the mandible and maxilla. Taiwo et al. and Liu et al. reported that the mandible exhibited a higher prevalence of tooth wear than the maxilla. A similar trend was observed in the present study in which tooth wear was significantly predominant in the mandible than the maxilla. This may be accounted for by the fact that the mandibular teeth provide grinding surface for the coarse and fibrous diet and also receive the masticatory forces generated during mastication.
In this study, the molars and premolars showed greater wear than the incisors, and incisors showed greater wear than canines in both the mandibular and maxillary dentition. This result is at variance with the findings of other researchers who documented that incisors and canines showed greater wear than molars, and molars showed greater wear than premolars in both the maxillary or mandibular dentition. The higher level of wear in the molars and premolars in this study may be related to the difference in etiologic factors of tooth wear reported among Nigerians and other population which account for more attrition in Nigerians than other population. The high fibrous diet and the chewing and crushing of bones by Nigerians would not only promote attrition, but this dietary habit would also facilitate tooth wear on the molars and premolars since these teeth are used for mastication and receives the masticatory forces generated during mastication.
| Conclusion|| |
The results of this study compare with the findings of other Nigerian studies in a similar population. The prevalence of tooth wear among the elderly was high, mild, and moderate tooth wear was the most common grade of tooth wear, attrition occurred more commonly than other forms of tooth wear and tooth wear significantly occurred in the mandible than the maxilla. However, when compared to other studies in similar population from Western cultures and China, the observed pattern of tooth wear was different. Attrition was more common than erosion and tooth wear was more likely to occur in the molars and premolars than incisors and canine in the present study. This further supports the fact that the etiological factors responsible for tooth wear are different among Nigerians and other population. Therefore, there is a need to develop appropriate local measures for the prevention of tooth wear lesions.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]