Abstract
Background: Loss of permanent teeth can have negative
functional, psychological and social consequences, especially for
children and adolescents with growing bone structures. Knowledge of
their causes is of interest in the development of comprehensive
dental public health programs. The objective of this study was to
evaluate the reasons for extractions of permanent teeth in children
in public oral structures in Dakar.
Material and method: A retrospective descriptive study, based
on consultation registers and patient records, was performed.
Patients between the ages of 6 and 15 who had permanent tooth
extractions between January 2014 and August 2018 were included.
A questionnaire including socio-demographic data, reason for
consultation, reason for extraction and extracted teeth was included
allowed to collect the data.
Results: A total of 321 patients aged 6 to 15 years received 375 permanent tooth extractions (1.16 teeth / child). Dental caries
and its complications were the main reasons for extractions (94.7%).
Conclusion: Dental caries remains a real public health problem in developing countries. Decision-makers need to focus on
strategies for the prevention and management of early childhood oral conditions to avoid the extraction of permanent teeth.
Keywords: Reasons for Extraction; Permanent Teeth; Child, Tooth Decay; Senegal
Introduction
The extraction of permanent teeth should not be an insignificant
act, especially in children, because of the negative repercussions
on eruption phenomena, the harmony of the arches, the primary
functions of chewing, swallowing, breathing and phonation.
Indeed, the first permanent molar, which is the first permanent
tooth to erupt, is the keystone of the occlusion; it determines the
shape of the lower part of the face and conditions the position
and health of the other permanent teeth [1]. The decision to
extract permanent teeth must be reasoned and integrated into a
global treatment plan that often requires collaboration with other
dental specialties. The analysis of the causes of permanent tooth
loss is of interest to practitioners and decision-makers in order
to develop control strategies to be integrated into overall dental
public health programs. It is from this perspective that an indirect
method based on the search for reasons for these permanent
tooth losses by extraction has been developed and used in many
countries. Numerous studies on the causes of permanent tooth
extraction in children, adolescents and adults have been conducted
in industrialized countries [2-5] and caries and periodontal disease
have been the main causes of extractions. In Africa, studies are rare.
The main objective of this study was to evaluate the reasons for
extractions of permanent teeth in children in public oral structures
in Dakar.
Materials and Methods
This was a descriptive retrospective study of patients
consulting the oral structures of Aristide Dantec Hospital (HALD),
Albert Royer National Children’s Hospital of Fann (CHNEAR), Dakar
Institute of Odonto-Stomatology (IOS) and Grand Yoff General
Hospital (HOGGY). Patient selection was based on consultation
records. All records of patients aged 6 to 15 years who received
permanent tooth extractions were included in the study. A
“reasoned choice” sampling was conducted. A data sheet was used to collect information on socio-demographic data, the reason
for consultation, the reasons for extraction, and the type of teeth
extracted. The collected data were analysed with the SPSS 20.0 IBM
software. The quantitative variables were described by their means
and standard deviations. The qualitative variables were described
by their numbers and percentages.
Results
Among 26362 children consulted, 321 patients (1.21%) aged 6
to 15 years had received permanent tooth extractions. The number
of permanent teeth extracted was 375 (1.16 teeth/child). Girls had
received 55.2% of extractions. The number of permanent teeth
extracted was 375 (1.16 teeth / child). Girls had received 55.2% of
extractions. The 12-15 age group had benefited from 77.88% (Table
1). The distribution of extractions by health centre was 33.64%
in the CHNEAR and 31.77% in HOGGY (Table 2). The first molars
accounted for 76.94% of the extracted teeth (Table 3). Dental
caries and its complications were the main reasons for extracting
permanent teeth in 94.16% of cases (Table 4). Pain was the reason
for consultation for 74.8% of extracted teeth (Figure 1).
Figure 1: Breakdown by reasons for consultation.
Table 1: Distribution of extractions by age group.
Table 2: Distribution of extractions according to the host
structure.
Table 3: Distribution of extractions according to tooth type.
Table 4: Distribution by extraction reasons.
Discussions
The health structures selected in this study have the
particularity of being centres receiving many patients for general
health and oral health care. In addition, the CHNEAR and the IOS
have services exclusively oriented towards the oral care of children
and adolescents. The prevalence of permanent tooth extractions
seems low but not negligible given the key role played by these
teeth and in particular the first permanent molar. This result is
lower than that reported by Murray et al [6] and Johansen et al [7].
This could be explained by the difference in the study population,
which was made up of adults and elderly subjects (20-50 years
and >70 years). Children in the 12-15 age group received more
extractions than others. This shows that the number of permanent
teeth extracted increases with age. Pain was the main reason for
consultation and concerned the majority of patients. Studies by
several authors [8,9] have produced similar results. This is linked to
an economic situation and/or a lifestyle that is not compatible with
a “preventive-conscious” approach. Difficulties in access to dental
care, lack of dental facilities, lack of financial resources or lack of
information and education on oral health may constitute a barrier to
systematic visits or consultations as soon as the first signs of dental
problems appear [10]. Dental caries and its complications were the most
common reasons for extraction of permanent teeth. The first
permanent molars were the most frequently extracted teeth. These
data support the results of Shammari et al [11] who reported that
dental caries was the leading cause of permanent tooth extractions
in patients under 40 years of age and that the first permanent
molars were the most affected teeth. Other studies [12-17] have
shown that the first permanent molar was the most extracted
tooth with prevalence ranging from 11.7% to 86.2%. A study by
Safadi et al [18] in subjects aged 13 to 20 years showed that the
prevalence of extractions of the first permanent molars was 31.3%,
of which 76.5% concerned the first lower molars and that dental
caries and its consequences were the main reasons for extraction.
The greater susceptibility of the first molars to extraction can be
explained by several factors. Their eruption, usually around 6 years
of age, is silent and usually goes unnoticed, resulting in defective
brushing. They have an occlusal surface whose morphology is
more favourable to the retention of soft cariogenic deposits [19].
However, given their important roles, especially in children and
adolescents, their extraction should be the ultimate therapeutic
choice.
Conclusion
It should be noted that dental caries and its complications are
the main reasons for the extraction of permanent teeth in children.
It is important to implement a policy of promotion, prevention and
early management of oral diseases in children aged 12 to 15 years
in order to reduce dental loss.
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