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DENTAL
TREATMENT NEEDS IN
m~IVERSITY DENTAL HOSPITAL
ADULT
PATIENTS
VISITING
THE
Investigator: ODffiAIvfBO ERIC
SUPERVISORS:
INTERNAL: DR. LOICE GATHECE
BDS (UoN) IvfPH (UoN)
Senior lecturer, Department of periodontology, community and
Preventive dentistry
School of Dental sciences
University of Nairobi.
EXTERNAL: DR. O. AWANGE
Senior Lecturer, Department
Pathology\Oral Medicine
School of Dental Sciences
University of Nairobi
of Oral &Maxillofacial
Surgery & Oral
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:-ABLE OF CONTENTS
LIST OF ABBREVIATIONS
INTRIODUCTION
LITERATURE REVIEW
RESEARCH PROBLEM:
.PROBLEM STATEMENT
STUDY JUSTIFICATION
Main objective:
Specific objectives:
Hypothesis
VARIABLES INVESTIGATED:
MATERIALS AND METHODS:
Study area:
Study popuiation:
INCLUSION CRITERIA
EXCLUSION CRITERIA
Sample size determination:
Sampie methods:
DATA COLLECTION, INSTRUMENTS AND TECHNIQUES:
DATA ANALYSIS AND PRESENTATION
ETHICAL CONSIDERATION:
LOGISTICAL CONSIDERATION:
EXPECTED BENEFITS:
REFERENCES
CLINICAL EXAMINATION FORM
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LIST OF ABBREVIATIONS
US
United States of America
CPITN
Community Periodontal Index of Treatment Needs
TIPS
Journal ofIndian Prosthodontic Society
DHC
Dental Health Component
JADA
Journal of American Dental Association.
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SUTvirviARY
The dental treatment needs of adults in Kenya are high but the demand for dental services
remains very low. Some people ignore these ailments and only seek treatment when they
experience pain. Few of them do not seek treatment, not by choice, but due to lack of
money to address their problems.
This descriptive cross sectional study will be conducted on any patient attending the oral
diagnosis clinic. A total of 132 patients aged 18 years Andover will be selected to the
study. Systematic random sampling method will be used. A clinical examination form
will be used to record data.
Data collected will be analyzed with a computer using the SPSS program. Descriptive
statistical tests will be carried out to explain the frequency of various variables. The chi
square tesr will be used to determine the relationship between categorical variables. Data
will then be presented in tables, bar graphs and pie charts.
The information obtained from the research could be used to formulate policies that will
best address the treatment needs of adult patients visiting the university dental hospital.
The research project is also to satisfy the requirements
for the
undergraduate degree
course in dental surgery.
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INTRIODUCTION
Treatment needs generally refer to professionally determined or normative needs related
to the presence of disease. Although
most dental and oral disorders
are not life
threatening, they may have systemic effects and can greatly reduce a person's quality of
life. Poor oral hygiene and inadequate
dental check-ups are major risk factors for
developing dental and oral disorders.
According to JADA
dental caries is one of the most common childhood
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diseases.
Prevalence increases with age.51.6% of the children had at least one carious lesion or
filling in the coronal portion of either a primary or a permanent tooth. These proportions
increased to 77.9% for 17 year-olds and 84.7% for adults 18 years and over.Also, most
adults, 25 years and over have periodontal disease with at least 2mm attachment loss or
more. The percentage of adults with 6mm or more loss of attachment at one or more sites
increases at older age groups, with 19% of 55--64 year olds and 23.4% of65-74 year olds
having this amount of loss or more. At all ages, men are more likely than women to have
at least one tooth site with a 6mm or more loss of attachment. In addition to age and sex,
the prevalence of periodontal
loss of attachment also varies by racial\ethical
groups.
concerning tooth loss and edentulisrn, Phipps & Stevens (1995) and Neissen and Weyant
(1989) observed that most teeth are lost because of periodontal
caries.Byage
disease or dental
17 years, more than 7.3% of US children have lost at least one permanent
tooth because of caries. By age 50 years, Americans have lost an average of 12.1 teeth,
including the third molars. Men and women are nearly equally likely to be edentulous.
JADA also states that every year, about 1.2 million people develop cancer in the US
(based on 2000 estimates).Sites in the oral cavity and pharynx account for about 30,200
cases(2.4% of all cancers),and about 7,800 Americans die from these cancers each year.
The median age at diagnosis of oral and pharyngeal cancer is 64 years, and the rate of
occurrence increases with age. More than 95% of oral cancers occur in individuals aged
35 years and older. Overall 5-year survival rate for people with oral cavity and
pharyngeal cancer is 52%. The incidence for oral and pharyngeal cancer is decreasing
with an estimated annual percentage
decrease of 0.5% per year between
1975 and
1996.Tobbaco use bas been estimated has been estimated to account for over 90% of
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cancers of oral cavity and pharynx., and thus presents the greatest single preventable risk
factor for oral cancer.
Other oral diseases
include oral herpes simplex infection
(prevalence is between 15-40%), recurrent apthous ulcers (prevalence between 5-25%),
and other mucosal conditions
like denture stomatitis (25.6% of 18 years and older
patients who have 2 fun dentures, 32.2% of those with one full denture, 26.7% of those
with one or more partial dentures and 0.87% of those without full or partial denture) and
candidiasis.
In a study by Astron & Kada to determine the perceived dental treatment needs among
older Tanzanian adults
2,
it was found that despite a moderate level of oral diseases, the
prevalence of perceived need for problem oriented care, dental check-ups and any type of
care was substantial
among older Tanzanians.
More over, socio-dernographics
reported oral health outcome variables alongside
correlates of need perceptions
clinical indicators
and
were important
across the outcome measures employed
in the study.
Brindle R, Wilson D,Harrison A,Connoly C and Cleaton Jones ,in a study to investigate
rates of dental caries and periodontal diseases, available dental service and resources and
perceived needs in a rural South African community 3,observed that caries prevalence in
age groups 35-54 was 69%,and 80% in 55 years and over. Caries was untreated and
where present, treatment had been extraction.Periodonbtal
disease prevalence was high,
but would respond to improved oral hygiene.
The aim of this study therefore,
is to determine the dental treatment needs of adult
patients visiting The University of Nairobi Dental Hospital.
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LITERATURE
REVIEW.
A study of dental treatment needs of adults in Hiroshima prefecture (by Moshita
Masayuki and miyagu Msaharu of Hiroshima University)
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found that total amount of
needs for operative dentistry services was4.7 million teeth. The number of adults who
required periodontal treatment was estimated to be about 1.8 rnilllion.The number of
people needing prosthodontic treatment was estimated to be about 0.4 million.
In a study done in US between 1988-94,about use of
estimate periodontal
treatment
needs among
modified CPITN
approach to
adults aged 20-79 years by socio
demographic characteristics 5,it was found that at least 3% of adult US population
required complex periodontal treatment or oral hygiene instructions. In another study to
assess the periodontal disease using CPITN in a rural population in Nineveh, Iraq
6,
it
was observed that only 12.5% of the sample had healthy gums and teeth, and calculus
was the most frequently observed periodontal condition. Another study done to show
periodontal treatment needs in Philippine adults
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using CPITN showed that calculus
predominated as the most frequently recorded score, with a prevalence exceeding 70% in
young adults, but decreasing to about 40% in older adults. Decrease in prevalence of
calculus with age was associated with an increase in 4-5mm pocketing, 4% in young
adults and about 60% in older adults.Peridontally healthy mouths and cases of deep
pocketing were relatively uncommon. Assessed treatment needs were predominantly
scaling and improved oral hygiene. Need for complex treatment was low, involvimg only
4% of older adults. The pattern of assessed periodontal treatment needs of adults in the
Philippines was indicative of endemic gingivitis & calculus and moderate to low
prevalence of pocketing. In Saudi Arabia, a study to determine periodontal treatment
needs of adults 8found that the level of need for periodontal care in the sample chosen is
low when comparing to other countries. In Finland, a study to determine periodontal
treatment needs of the population aged 30 years and over
9,
observed that 3.4% had
healthy periodontal status, while plaque retention was found in 96.6% of the subjects.
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In a study to determine the prosthodontic treatment needs of Canadian adults aged 85
years and over
10,
it was observed that only 31% of dentate nursing home residents and
47% of dentate independently
living subjects had received dental care in the year
previous to examination. The overall prevalence of edentulism was 66% and about 80010
of subjects wore at least one denture. Of the dentate subjects, over 60% had untreated
decay and 47% of nursing home residents had untreated root decay. Among nursing
home residents,
about 45% of dentate subjects required tooth extractions
required prosthodontic
and 56%
treatment. Although only 27% of dentate independently
residents required tooth extractions,
over 60% needed restorative
treatment.
living
Higher
prevalence of both untreated decay and unmet treatment need was associated with lower
utilization
of dental care for dentate
treatment
need was required
subjects.
For edentulous
subjects,
by 70% of nursing home residents
prosthetic
and by 51% of
independently living subjects. In a study by Marete Vigild about denture status and need
for prosthodontic treatment among institutionalized
that 67% of sample had normative
need
elderly in Denmark Il,it was found
for prosthodontic
treatment.
It was also
concluded that the prosthodontic treatment among institutionalized elderly in Denmark is
far from being met.
Bernabe & Flores did a study to determine orthodontic treatment need in Peruvian young
adults
They observed that about a third of the sample presented severe or very severe
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malocclusion.
No significant
difference
was found in treatment
needs between the
different sexes. In this population, malocclusion was characterized by a relatively high
frequency of missing teeth, appreciable dental crowding and inadequate antero-posterior
relationships. In a study entitled orthodontic treatment needs in Asian adult males
13,
it
was observed that 50% of the sample had a definite need for orthodontic treatment (DHC
grades 4&5), whereas 29.2% had a moderate need for treatment (DHC grade 3).The
occlusal trait most commonly observed was dental cross bite.
In a study by Hawkins, RA & Locker to determine the need for tooth extractions
14,
it
was observed that 38% of nursing home residents and 21% of independently living
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subjects required 1 or more extractions. The number of teeth indicated for extraction were
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1.4 and 0.6 respectively .Among the nursing home residents,caries
reason
was more often the
for extraction for almost all tooth types, but for independently living subjects,
periodontal reasons were more common.Overall,a
significantly
higher proportion
of
nursing home residents needed extraction for both caries and periodontal reasons(25% &
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16%),compared to subjects who lived independently( 10 & 11%).In a study by Clarkson
to investigate distribution and type of restorative treatment 15'itwas observed that 85% of
the patients had received a restoration or extraction,37% of these for caries and 63% for
other reasons. The proportion of adults who received treatment by age group differed
significantly, with those aged 25-34 years being least likely and those aged 35-44 years
being most likely. In a document entitled endodontic treatment and periapical health in
patients in the institute of dentistry in Odz 15,it was observed that the mean number of
endodontically
treated teeth increased with age ranging from 1.4-3.4 from ages 20-70
years and older.
endodonticaliy
Of 10,054 radiographically
examined
teeth,
9.7% were treated
whereas 5.5% exhibited periapical pathology. Percentage of teeth with
periapical lesions was significantly
higher in men as compared to women (6.2% vs.
5.0%).The prevalence of orthodontic treatment and apical periodontitis
increased with
age. The prevalence of apical periodontitis also differed with sex.
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RESEARCH PROBLEM:
.PROBLEM STATElViENT
Dental treatment need has been reported to be high in the world and it affects people of
different races, gender and socio-economic
status. However, people tend to seek dental
treatment only when they have signs and symptoms e.g. pain. After these are addressed,
patients do not come for follow up, thus the need for treatment still remains high even
among dental patients in the population.
STUDY JUSTIFICATION
There is inadequate information pertaining to dental treatment needs of adult patients in
Kenya The findings of this study will form a benchmark and could be used to plan for
the various patient needs for the patients visiting the school.
Main objective:
To determine the dental treatment needs among adults.
Specific objectives:
To determine the periodontal treatment needs.
To determine the conservative treatment needs.
To determine the surgical treatment needs.
To determine the prosthetic treatment needs
To determine orthodontic treatment needs
Hypothesis
Conservative treatment need is the most frequent treatment need among patients visiting
the university of Nairobi dental hospital.
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VARiABLES iNVESTiGATED:
Independent variable
•• Age
•
Sex
•• Dental history
Dependent variables:
Needs for prosthetic attention
II
-complete dentures
•• -partial dentures
Periodontal treatment needs.
•• oral hygiene instructions and motivations
II
scaling, root planning and po lishing
Surgery
•
Needf
for extraction
Conservative treatment needs
•• -permanent restoration
•
-Root canal treatment.
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MATERIALS AND rviETHODS:
Study area:
The study will be conducted in the university of Nairobi Dental Hospital. This hospital is
located along valley road, opposite Nairobi hospital. The University of Nairobi runs this
hospital. The hospital serves Nairobi residents and the neighboring towns.
Study popuiation:
It will include all patients above the age of 18 years.
INCLUSION CRITERIA
1. Patients aged 18 years and above
2. Patients who will consent.
EXCLUSION CRITERIA.
1. Patients below 18 years of age.
2. Patients who do not consent.
Sampie size determination:
where Z=sample size
p=prevalence (assumed to be 50%)
Confidence is 95%
Z=Z value
.1.96.
C=I -confidence level
N=I.962
* 0.5 (1-0.5)
(1-0.95)2
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=0.9604
0.0025
=384.16
=384, for a population of more than 10000.
For a sample less than 10000,
nf=n! (1+n/N)
Where nf=desired sample size
n=sample size as calculated for population more than 10000
N=population size
=3841 (1+384/200)=384/2.92=131.51=132
Sampie methods:
Systemic random sampling method will be used. Every second patient sitting in the oral
diagnosis clinic will be included in the study.
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DATA COLLECTiON,
Ir~STRUrviENTS AND TECHNiQUES:
Data will be collected by examining patients in the hospital's oral diagnosis clinic. A
clinical examination form will be used for data collection. Dental hand instruments will
be used for examination.
DATA ANALYSIS AND PRESENTATION
Data collected will be analyzed with a computer using the SPSS
Program 12.1.Descriptive statistical tests will be carried out to explain the frequency of
various variables. Data will be presented in tables, bar graphs and pie charts.
ETHiCAL CONSiDERATiON:
1. Authority to conduct the study will be sought from Kenyatta National Hospital ethical
committee.
2. Permission will be sought from University dental hospital administration.
3. Informed consent will be sought from patients
4. Information obtained from patients will be treated with confidentiality.
5. Study will be for the benefit of the community.
LOGiSTiCAL
CONSiDERATiON:
-Financial constraint.
-Limited time for study.
EXPECTED BENEFiTS:
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•
The research will act as baseline data for future research.
•
Results of the study will assist the university in planning on how best to meet the
treatment needs of patients visiting the hospital
•
The research will be submitted for the partial fulfillment of the requirements of dental
surgery.
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REFERENCES
1. National Institute of Dental and Craniofacial Research, National Institute of Health
Behesda, MD 20092-2190 301-496-4261
2. Anne N Astron,Irene
N Kada; perceived
dental treatment
needs among older
Tanzanian adults;BMC Oral Health2007,7;9;10, 1186\14
3. Brindle R, Wilson D,Harrison
A, Connoly C, Cleaton Jones; rates of dental caries and
periodontal disease; International Dental Journa1.2000 Feb;50(1); 13-20
4. M Masayuki.M
Msaharu.dental
treatment needs of adults in Hiroshima;Joumal
of
Dental Health, 1999. vo 1.49; 785
5. Dye B A, Vargas C M, Use of modified CPITN to estimate periodontal treatment
needs among adults(20-79 yrs);Community Dent Health,2002 Dec;19(4);215-23
6. T Y Khamrco;use of CPITN to assess periodontal disease in a rural population in
Nineveh, Iraq; Eastern Mediterranean Health Journal; vol.5, issue 3, 19999;549-555
7. Yupin Songpaisan,George
N. Davis; periodontal treatment needs in Philippine adults
Community Dentistry and Oral Epidemiology; vo1.14, issue 6;313-316
8. F E Guile; periodontal status of adults in central Saudi Arabia ;Community Dentistry
and oral epidemiology;vol.20,issue
9. Matti Rajala,Keijo
Finnish
population
Paunio
3;159-160
.Hellena
Markkanen;periodontal
treatment
needs of
aged 30 years
and over Community
Dentistry
and Oral
Epidemiology; vol.l l , issue 1;25-32 (Feb. 1983)
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10. Hawkins R J,Main P H,Locker D; Oral health status and treatment needs of Canadian
adults aged 85 years and over: Special care in Dentistry; vol. 18, issue 4; 164169{July 1998)
11. Marete
Vigild,denture
institutionalized
status
and
need
for
prosthodontic
treatment
among
elderly in Denmark; Community Dentistry and Oral Epidemiology
;vo1.15,issue 3;128-133
12. Eduardo
adults,
Bernabe,Carlos
International
Floresl;orthodontic
Journal
of
treatment
needs
Orthodontists
III
Peruvian
and
young
Dentofacial
Orthopedics;vol. 76,no.3;796-773
13. Jen Soh,Andrew Sandham;Orthodontic
treatment needs in Asian adult males; The
Angle Orthodontist; vol. 74, no.6;796-773
14. HawkinsRl,MainRA,LockerD;need
for tooth extractions; Geronto logy, 1997; 14(2);75-
8
15.1
Clarkson;distribution
and
type
of
restorative
treatment;Przeglad
Epidemiology,2005;vol.59(no.l);107-115
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CLINICAL EXAMINATION
FORM
NAME
AGE
SEX
OCCUPATION
RESIDENCE
FILE NUMBER
DATE
.
.
.
.
.
.
.
PERIODONTAL NEEDS
LOSS OF ATTACHMENT
16
26
11
O=O-3mm
1=4-5mm
2=6-8mm
46
31
36
3=9-1Imm
4=12mm or more
X=excluded sextant
9=not recorded
GINGIVA
O=healthy
1=bleeding
2=ca1culus
16
11
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46
31
26
36
NOTE: incase of absence of the specified tooth, use the most mesial tooth present.
DENTITION STATUS AND TREATMENT NEED
STATUS
O=sound
1=decayed
2=filled with decay
TREATMENT
O=none
p=preventive care to arrest caries
1=1 surface filling
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3=filled, no decay
4=missing
9=not recorded
2=2 or more surface fillings
3=crown for any reason
4=endodontic treatment
9=not recorded
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161514
13
121121
2223
2425
262728
crown
root
treatment
484746
45 44 43 42 41 31 32 33 34 34 36 37 38
crown
root
treatment
PROSTHETIC STATUS
O=no
upper
lower
prosthesis
l=bridge
2=more than bridge
3=partial denture (pd)
4=both bridge & pd
5=complete denture
9=not recorded
PROSTHETIC NEED.
Upper
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lower
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O=no prosthesis needed
1=need for partial denture
2=need for need for complete denture
9=not recorded
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DENTOF ACIAL ANOMALIES
Missing teeth
Spacing in incisor segment s
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Q=no spacing
1= 1 segment spaced
2=2 segments spaced
Crowding in the incisor segments
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Q=no crowing
1=1 segment crowded
2=2 segments crowded
OCCLUSION
Anterior maxillary over jet in mm
Vertical anterior open bite in mm
.
Angle's molar relationship
.
.
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