| Abstract|| |
Background: Rampant caries in adults has not been a focus of many researches unlike the childhood form of the disease. The disease is an interesting finding in an adult patient. When the condition occurs in children, it has been described as nursing bottle caries, baby bottle tooth decay, and the most recently adopted term, "early childhood caries".
Aim: The aim was to determine the prevalence of rampant caries among adult patients.
Materials and Methods: Cases of rampant caries were identified from the records of all the patients treated during a 5-year period. Variables considered included the socio-demographic data, frequency of consumption of cariogenic diet, social habits, decayed, missing, filled teeth (DMFT), socioeconomic status (SES), and oral hygiene (OH), etc. Data were analyzed using student's t-test and one-way ANOVA for continuous variables, while Fishers exact test was adopted for categorical variables. Level of significance was set at P < 0.05.
Result: Less than 1% (21 out of 3458) of patients treated during the period had adult rampant caries, but only 17 patients with complete data were analyzed. The age range of the patients was 22–61 years with a median of 36 years. The number of teeth with open carious cavities ranged from 8 to 18, with a mean of 11.6 ± 3.3 teeth. A statistically significant difference was found in the number of open carious cavities and gender (P = 0.03), and between the SES and OH (P = 0.001). Patients in low SES had the poorest OH, The number of open carious lesion was higher in those that consumed refined sugar regularly.
Conclusion: Occurrence of rampant caries was low and related to low socioeconomic status and regular consumption of cariogenic diet.
Keywords: Adult, rampant caries, retrospective study
|How to cite this article:|
Deborah M A, Abiodun-Solanke Iyabode M F, Shakeerah O G. A 5-year retrospective study of rampant dental caries among adult patients in a Nigerian Teaching Hospital. Indian J Dent Res 2015;26:267-70
Dental caries is a multifactorial infectious disease, the aggressive form of which has been previously termed "rampant caries." Although the disease condition has been given numerous definitions and synonyms in the past, there are still no specific criteria with regards to the number of carious lesions or the rate of cavity development that could be used to make the diagnosis. The term has, however, been loosely applied to any clinical case marked by an alarming amount of carious destruction or remarkably rapid attack rate. When the condition occurs in children, it has been described as nursing bottle caries, baby bottle tooth decay, and the most recently adopted term, "early childhood caries (ECC)." The disease of ECC has been defined as "presence of one or more decayed (noncavitated or cavitated lesions) missing (due to caries) or filled tooth surfaces in any primary tooth in a child 71 months of age or younger.,
|How to cite this URL:|
Deborah M A, Abiodun-Solanke Iyabode M F, Shakeerah O G. A 5-year retrospective study of rampant dental caries among adult patients in a Nigerian Teaching Hospital. Indian J Dent Res [serial online] 2015 [cited 2020 Apr 2];26:267-70. Available from: http://www.ijdr.in/text.asp?2015/26/3/267/162885
Akpata et al. simply described rampant caries in adults as "adult severe caries." In addition, they defined it as caries in patients aged 16 years or older with multiple open coronal carious cavities (at least 8) including caries of an anterior tooth (mandibular or maxillary incisor or canine). The lack of strict diagnostic criteria may have been partly responsible for the little published data on the incidence and prevalence of rampant caries in the adult population.
The prevalence of ECC varies in different population and may depend on the diagnostic criteria. A prevalence rate of 5%, was reported in some developed countries, whereas in North America populations, a prevalence of 11–72% was observed among high-risk children. In Kosovo (Southern Europe), the prevalence was 17.36%, while in Nigeria a prevalence of 5.5% was reported.
Adult severe caries has not been widely studied; however, Akpata et al. recorded a prevalence of 0.26% among patients attending Kuwait Dental Clinics and concluded that it was more common in the lower socioeconomic group. This retrospective study, therefore, set out to determine the prevalence or occurrence of rampant caries among adult patients presenting with dental caries in our center over the study period. The sociobehavioral and dietary factors were also reported in the patients with the condition.
| Materials and Methods|| |
This was a retrospective study of adult patients diagnosed with rampant caries, seen at the Conservation Unit of the Dental Centre, University College Hospital, Ibadan over a 5 years period (January 2004–December 2008). The criterion used for diagnosing rampant caries was based on Akpata et al. study which defined the condition as caries in patients aged 16 years or older with multiple open coronal carious cavities (at least 8), including caries of an anterior tooth (mandibular or maxillary incisor or canine).
Cases of rampant caries were identified from the records of all the patients treated during the study period. The variables extracted from the records included age, gender, patient's occupation, frequency of consumption of cariogenic diet, social habits (smoking and alcohol consumption), and related medical history (e.g., drug-induced xerostomia, salivary gland disease, or previous irradiation to head and neck region). Other variables included decayed, missing, filled teeth (DMFT) index, and oral hygiene index (OHI) using simplified OHI of Green and Vermillion. Cases with incomplete information were excluded from analysis. The occupational social class was determined, using a modified version by Famuyiwa and Olorunshola.
Statistical analysis was done using Statistical Package for the Social Sciences version 16 (SPSS Version 16.0, SPSS Inc Released Chicago 2007). Means ± standard deviation, Student's t-test, and one-way ANOVA were used for continuous variables, while Chi-square and Fishers exact test were adopted for categorical variables. Statistical significance was set at P < 0.05.
Ethical approval was granted by the University of Ibadan/University College Hospital Institutional Review Board with reference number 12/0083.
| Result|| |
The total number of patients treated during the period under review was 3,458. Twenty-one of these (0.61%) were diagnosed with rampant caries, but only 17 had complete data. Ten of the subjects (58.8%) were males and 7 (41.2%) were females. The age range of the patients was 22–61 years and the median was 36 years [Table 1]. None of the patients had a history of drug-induced xerostomia, salivary gland disease, or previous irradiation to head and neck region. Furthermore, none had a record of smoking or alcohol consumption.
The number of teeth with open carious cavities among the patients ranged from 8 to 18, with a mean of 11.6 ± 3.3 teeth with 18% of patients having 10 carious teeth each [Figure 1]. All the females had 8–13 carious teeth each, whereas an equal number of males had either 8–13 or 14–18 carious teeth each. There was a statistically significant difference in the number of open carious cavities between male and female (χ 2 = 4.96, P = 0.03). However, none of the remaining variables (age group, frequency of consumption of refined sugar, and OH) showed any statistical significant relationship with number of open carious cavities [Table 2].
|Figure 1: The number of carious teeth as seen in the patients presenting with rampant caries|
Click here to view
The relationship between mean DMFT and mean OHI with various variables are displayed in [Table 3]. Though the mean OHI was almost the same between male and female, the mean DMFT was higher in male. There was a statistically significant difference between the mean OHI and the socioeconomic status (SES) of the patients, with the low class having the poorest OHI. Furthermore, the mean DMFT was slightly higher in patients in low class than the high class, while patients in middle class had the lowest mean DMFT.
Patients that consumed refined carbohydrate regularly had higher mean OHI than those that take it occasionally. However, the mean DMFT was higher in those that consumed refined sugar occasionally, though not statistically significant (P = 0.86).
| Discussion|| |
The prevalence of the condition in this present retrospective study was found to be 0.61% as against 0.26% earlier reported among the adult patients in Saudi Arabia. The higher prevalence in this study may be due to the attitudes of the patients to oral health. Many patients in our environment do not have the habit of routine regular dental check-up. They only report to the clinics for symptomatic treatment and often engage in self-medications to relieve pain. The age range of our patients (22–61 years) also was within that reported by Akpata et al., but more males (58.8%) than females (41.2%), had the disease.
In the current study, the number of open carious teeth and mean DMFT index were higher in male than in female. There was statistically significant relationship between gender and the number of decayed teeth. Previous studies had reported a similar trend among younger age groups. There is a tendency for female to pay more attention to their oral health than males especially as people grow older, when the major priority for males is their job or career. Nevertheless, some authors, observed higher caries prevalence and DMFT index in females and the reasons given for such finding included earlier eruption in female children, regular dental visits, and more restorations in female.
The relationship between OH and dental caries has been widely reported, but the effect was inconclusive. Though it was suggested that OH is sufficiently effective to prevent or reduce dental caries, and poor OH was a major risk factor among adult patients with rampant caries seen in Saudi Arabia, other studies, did not find a positive correlation between good OH and absence of dental caries. Similarly, in the present study, a greater proportion of the patients with rampant caries had good OH and none had poor OH.
The frequency of intake of refined sugar was observed to be strongly correlated with the number of open carious teeth. The condition was worse among the people that reported regular consumption of refined sugar, with 4 out of 5 that had 14–18 carious lesions being regular consumers. The relationship between sugar and dental caries has long been established by Vipeholm study, other authors,, continued to demonstrate a direct linkage of frequent exposure to sugar with dental caries. The importance of dietary counseling in the control and prevention of dental caries should, therefore, be emphasized as opportunity presents itself. However, the mean DMFT was higher among the occasional consumers, indicating that these people had higher number of the missing and/or filled components, demonstrating that they may have had regular dental consultations than the other group. They may also have reduced the frequency of sugar consumption following the counseling received at previous consultations during which some of the teeth were filled or extracted.
The link between SES and health, including oral health is well-established. In contrast to what was previously reported, adult rampant caries was more prevalent (41.2%) among the middle class in this study. However, the proportion of people with highest number of open carious lesion was the same for both the high and the middle classes. This may support an earlier suggestion that dental caries in the developing country is a disease of affluence. The fact that the mean DMFT index was almost the same for both the high and low class despite the fact that the high class had more carious lesion was also interesting. This suggests that the low class had higher proportion of the other components of the index which in this study was found to be the missing component. Other studies, have also reported that the restorative index in our environment is low. This may not be unconnected to poor attitude to oral health care and the prevailing economy distress making tooth restorations unaffordable for many people. Oral health promotion and education should, however, be a focus in this environment since many people may not be able to afford dental restoration.
| Conclusion|| |
The occurrence of rampant caries among the study population was low and was found to be related to SES and high frequency of consumption of cariogenic diet.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Winter GB, Hamilton MC, James PM. Role of the comforter as an aetiological factor in rampant caries of the deciduous dentition. Arch Dis Child 1966;41:207-12.
Massler M. Teenage caries. J Dent Child 1945;12:57-64.
Davies GN. The management of rampant dental caries. Dent J Aust 1954;26:57-69.
Hilderbrandt GT, Thomas DL. Management of rampant caries. J Minn Dent Assoc 2009;88:35-45.
Kaste LM, Drury TF, Horowitz AM, Beltran E. An evaluation of NHANES III estimates of early childhood caries. J Public Health Dent 1999;59:198-200.
Drury TF, Horowitz AM, Ismail AI, Maertens MP, Rozier RG, Selwitz RH. Diagnosing and reporting early childhood caries for research purposes. A report of a workshop sponsored by the National Institute of Dental and Craniofacial Research, the Health Resources and Services Administration, and the Health Care Financing Administration. J Public Health Dent 1999;59:192-7.
Akpata ES, Al-Attar A, Sharma PN. Factors associated with severe caries among adults in Kuwait. Med Princ Pract 2009;18:93-9.
Ripa LW. Nursing caries: A comprehensive review. Pediatr Dent 1988;10:268-82.
Kaste LM, Selwitz RH, Oldakowski RJ, Brunelle JA, Winn DM, Brown LJ. Coronal caries in the primary and permanent dentition of children and adolescents 1-17 years of age: United States, 1988-1991. J Dent Res 1996;75:631-41.
Berkowitz RJ. Causes, treatment and prevention of early childhood caries: A microbiologic perspective. J Can Dent Assoc 2003;69:304-7.
Begzati A, Berisha M, Meqa K. Early childhood caries in preschool children of Kosovo – A serious public health problem. BMC Public Health 2010;10:788.
Adekoya-Sofowora CA, Nasir WO, Ola D. Rampant caries experience in a Nigerian Teaching Hospital population. Niger Postgrad Med J 2006;13:89-94.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
Famuyiwa OO, Olorunshola OA. Some family factors in sickle cell anaemia in Lagos Nigeria. Niger Med Pract 1998;35:70-8.
Omolase CO, Adeleke OE, Afolabi AO, Afolabi OT. Self medication amongst general outpatients in a Nigerian community hospital. Ann Ib Postgrad Med 2007;5:64-7.
Eslamipour F, Borzabadi-Farahani A, Asgari I. The relationship between aging and oral health inequalities assessed by the DMFT index. Eur J Paediatr Dent 2010;11:193-9.
Al-Malik MI, Rehbini YA. Prevalence of dental caries, severity, and pattern in age 6 to 7-year-old children in a selected community in Saudi Arabia. J Contemp Dent Pract 2006;7:46-54.
Pakpour AH, Hidarnia A, Hajizadeh E, Kumar S, Harrison AP. The status of dental caries and related factors in a sample of Iranian adolescents. Med Oral Patol Oral Cir Bucal 2011;16:e822-7.
Akpata ES, al-Attar A, sharma PN. Occurrence of Rampant caries Among Adult Attending Kuwait Dental clinics; 2007 (IADR/AADR/CADR 85th
General session and exhibition, Abstract no 2168).
Brunelle JA, Carlos JP. Recent trends in dental caries in U.S. children and the effect of water fluoridation. J Dent Res 1990;69:723-7.
Okeigbemen SA. The prevalence of dental caries among 12 to 15-year-old school children in Nigeria: Report of a local survey and campaign. Oral Health Prev Dent 2004;2:27-31.
Touger-Decker R, van Loveren C. Sugars and dental caries. Am J Clin Nutr 2003;78:881S-92.
Murray JJ. Prevention of Oral Diseases. 3rd
ed. Oxford University Press, Oxford; 1996. p. 3, 231.
Nahass M, Akpata ES. Management of rampant caries in Saudi adults. Case reports. Saudi Dent J 1996;8:145-9.
Lewis DW, Ismail AI. Prevention of dental caries. Can Med Assoc J 1995;152:836-46.
Gustafsson BE, Quensel CE, Lanke LS, Lundqvist C, Grahnen H, Bonow BE, et al.
The Vipeholm dental caries study; the effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontol Scand 1954;11:232-64.
Burt BA, Kolker JL, Sandretto AM, Yuan Y, Sohn W, Ismail AI. Dietary patterns related to caries in a low-income adult population. Caries Res 2006;40:473-80.
Hobdell MH, Oliveira ER, Bautista R, Myburgh NG, Lalloo R, Narendran S, et al.
Oral diseases and socio-economic status (SES). Br Dent J 2003;194:91-6.
Enwonwu CO. Review of oral disease in Africa and the influence of socio-economic factors. Int Dent J 1981;31:29-38.
Denloye OO, Ajayi DM, Bankole O. A study of dental caries prevalence in 12-14 year old school children in Ibadan, Nigeria. Paediatr Dent J 2005;15:147-51.
Ajayi DM, Denloye OO, Dosumu OO. The fluoride content of drinking water and caries experience in 15-19 year old school children in Ibadan, Nigeria. Afr J Med Med Sci 2008;37:15-9.
M F Abiodun-Solanke Iyabode
Department of Restorative Dentistry, College of Medicine, University of Ibadan, Ibadan
Source of Support: Nil, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]