Indian Journal of Dental Research

ORIGINAL RESEARCH
Year
: 2014  |  Volume : 25  |  Issue : 4  |  Page : 434--438

Association between socio-demographic variables and partial edentulism in the Goan population: An epidemiological study in India


Kathleen M D'Souza, Meena Aras 
 Department of Prosthodontics, Goa Dental College and Hospital, Goa, India

Correspondence Address:
Kathleen M D«SQ»Souza
Department of Prosthodontics, Goa Dental College and Hospital, Goa
India

Abstract

Context: Although, incidence of complete edentulism has decreased, partial edentulism is still prevalent in the country. This study aims to establish a relationship between socio-demographic variables, etiological factors, and partial edentulism. It also evaluates the prevalence of different classes of partial edentulism according to Kennedy«SQ»s classification. Materials and Methods: An institution-based, cross-sectional study was conducted on a randomly selected population in the state of Goa, India. The study group included patients who attended the Outpatient Department (OPD) of Prosthodontics during September to October, 2009. Data were acquired based on a pre-formed pro-forma (inclusive of a structured questionnaire and clinical examination) and was statistically analysed using the chi-square test. Results: A total of 423 participants were enrolled for this study. Three hundred and twenty-two individuals were partially edentulous indicating a prevalence rate of 76.12%. 54.97% were females. The peak was recorded in the age group of 24-34 years, 51.24% were un-employed, 54.97% belonged to the medium income group, 58.07% resided in urban areas, 48.45% belonged to the basic educational group and 54.35% had a fair oral hygiene status. Kennedy«SQ»s class III group (50.30%) was the most frequent type of partial edentulism. An association between the aforementioned characteristics and partial edentulism was recorded with a statistically significant association between partial edentulism and two characteristics, namely monthly family income and education. Conclusion: Partial edentulism is dependent on a combination of socio-demographic factors and the present study reveals a high prevalence rate of partial edentulism in the studied population.



How to cite this article:
D'Souza KM, Aras M. Association between socio-demographic variables and partial edentulism in the Goan population: An epidemiological study in India.Indian J Dent Res 2014;25:434-438


How to cite this URL:
D'Souza KM, Aras M. Association between socio-demographic variables and partial edentulism in the Goan population: An epidemiological study in India. Indian J Dent Res [serial online] 2014 [cited 2021 Mar 2 ];25:434-438
Available from: https://www.ijdr.in/text.asp?2014/25/4/434/142519


Full Text

Epidemiological surveys were conducted globally to ascertain the impact of oral diseases. [1] These studies indicated an association between socio-demographic factors, lifestyles, and tooth loss. [2],[3],[4],[5] Moreover, such surveys help gather information necessary to assess treatment needs. [1] However, in India, due to limited resources and exploding population, a nation-wide survey is a daunting task. Nevertheless, state-wise surveys can be performed to elucidate the epidemiological trends in oral health. This study aims to assess the association of socio-demographic factors, such as age, gender, residency, socio-economic status, literacy, occupation, income, and oral hygiene, with partial edentulism in the state of Goa. It also assesses the incidence of different classes of partial edentulism according to Kennedy's classification.

 MATERIALS AND METHODS



This cross-sectional study was conducted in an institution-based setup of Goa Dental College and Hospital (GDC and H), Bambolim, situated in the Tiswadi taluka of the North Goa district, at a distance of 5 km from the state capital. According to the Indian census of 1951-2001, the total population [6] of Goa is 1,347,668 with a density of 363 people per square kilometer. [7] The total number of males is 687,248 and females is 660,420. [6] Goa has the highest proportion of urban population with 49.76% living in urban areas. [7] It has a literacy rate of 82% with 89% males and 76% females. [8]

The sample size of 384 patients was calculated using the single proportion formula. Four hundred and twenty-three participants were enrolled in the study assuming a non-response rate of approximately 10%. These were patients who attended the OPD of Prosthodontics during September-October 2009. The study participants were enrolled when they met the following inclusion criteria: (1) participant is a Goan, (2) participant is above 14 years of age, and (3) participant has only permanent dentition. A proforma including a structured questionnaire was prepared, followed by an oral examination of the patients. [9] The questionnaire was designed to collect data that would help ascertain the relationship between the aforementioned variables and the prevalence of missing teeth. It included the participants' age, gender, socio-economic status, demographic background, oral health practices, past oral history, purpose for replacement of teeth and preferred treatment option.

To prevent bias in data documentation, the survey data was collected by a single individual. Clinical examinations were conducted in accordance with the procedures and diagnostic criteria recommended by the World Health Organisation (WHO), 1997. [9] Natural daylight, plane mouth mirrors and periodontal probes were used to examine the oral hygiene and the teeth present in the oral cavity.

The socio-economic status was evaluated considering three factors: level of literacy, occupational status and monthly family income, [10] as described in [Table 1]. The oral hygiene status was assessed using the Simplified Oral Hygiene Index (OHI-S). A statistical software (SPSS version 15, SPSS Inc, Chicago, IL, USA) was used for data analysis. Chi-square tests were performed and P values were calculated for each characteristic. Results having P value <0.05 (95% level of confidence) were considered statistically significant.{Table 1}

 RESULTS



The study population comprised 423 individuals between the age group of 14-74 years. Of these, 196 (46.34%) were males and 227 (53.66%) were females. There were 322 partially edentulous patients indicating a prevalence rate of 76.12%, 64 completely edentulous patients (15.13%) and 37 completely dentulous patients (8.75%). The completely edentulous and completely dentulous individuals formed the group of non-partially edentulous patients.

As shown in [Table 2], 177 (54.97%) female and 145 male (45.03%) patients were partially edentulous. A peak in the prevalence rates of partial edentulism was demonstrated between the age group of 24-34 years, with females exhibiting the maximum prevalence rates of 29.38%. Out of 322 partially edentulous patients, 165 patients (51.24%) were unemployed and 187 patients (58.07%) resided in urban areas. Based on the monthly family income, 177 patients (54.97%) belonged to the medium income group, 78 patients (24.22%) belonged to the high income group and 67 patients (20.81%) belonged to the low income group. Distribution based on educational status indicated that 156 patients (48.45%) belonged to the basic group, 130 patients (40.37%) belonged to the secondary group, and only 36 patients (11.18%) belonged to the illiterate group. There was no statistically significant correlation between partial edentulism and aforementioned characteristics except in the case of monthly family income where the calculated P value was 0.0009 and education where the calculated P value was 0.005.{Table 2}

In addition, based on the oral hygiene status, 175 patients (54.35%) belonged to the fair group, 88 patients (27.33%) belonged to the poor group and 59 patients (18.32%) belonged to the good group.

One hundred and seventy-two partially edentulous patients (53.42%) had missing teeth in both their jaws, 94 patients (29.19%) had teeth missing only in the lower jaw and 56 patients (17.39%) had teeth missing only in the upper jaw.

It was also observed that decay (83.85%) was the most common cause of tooth loss in the study population, as indicated in [Table 3] and function (57.45%) was the most common reason for replacement of missing teeth, as indicated in [Table 4]. It was observed that 159 partially edentulous patients (49.38%) preferred fixed treatment, 119 patients (36.96%) preferred removable treatment and 44 patients (13.66%) deemed both options as acceptable, as indicated in [Table 5].{Table 3}{Table 4}{Table 5}

[Figure 1] and [Figure 2] illustrate the distribution of different classes of partially edentulous patients according to Kennedy's classification in the upper and lower arches, respectively. There was no statistically significant correlation between the classes of partial edentulism and gender in the upper arch. However, there was statistically significant correlation in the lower arch. Kennedy's class III group (50.30%) was the most frequent type of partial edentulism, followed by class II (23.94%), class I (19.27%) and the least frequent being class IV (6.49%). [Figure 3] illustrates the distribution of partially edentulous patients with respect to the number of missing teeth. Out of 322 patients, 64 patients (19.88%) had only one missing tooth, followed by 63 patients (19.57%), who had two missing teeth.{Figure 1}{Figure 2}{Figure 3}

 DISCUSSION



Edentulism has a significant impact on health and the overall quality of life. Studies on self-perception have demonstrated that tooth loss is associated with aesthetical, functional, psychological and social impacts on individuals. [11],[12],[13] Moreover; there is sufficient evidence to indicate that loss of teeth can adversely affect food selection and ultimately result in incidence of various health disorders. [14],[15],[16]

Numerous studies have been carried out globally to investigate the effects of socio-demographic factors and life style on the prevalence of tooth loss. However, exploding population and inadequate resources, in a developing country like India, have limited the feasibility of such studies. Hence, state-wise surveillance of these characteristics can be undertaken to draw up a nationwide prevalence rate of partial edentulism. This study reported a prevalence rate of 76.12% of partial edentulism in a randomly selected population of Goa. This was comparable to the prevalence rate of 74.6% reported in an epidemiological study conducted by Prabhu et al. in a rural population of the Udupi district, Karnataka. [17]

Various studies indicated a strong association between age and sex of the patient to edentulism. [2],[5],[18],[19] Nonetheless, contradictory studies refuted positive association between these studied characteristics and partial edentulism. [20],[21] Hence, this study has attempted to elucidate such an association. It was observed that a majority of the study population comprised partially edentulous female patients (54.97%) with the peak of the prevalence rate being observed in the age group of 24-34 years. This study also noted more females to be interested in acquiring dental treatment and replacement of missing teeth compared to males.

Recent studies on self-perception of prosthodontic needs indicate that gender plays a major role. [11],[22] It was observed that women perceive greater impact of oral health on the quality of life than men. In recent decades, the prevalence and extent of tooth loss have decreased in many countries. [23],[24],[25],[26]

This decline may be attributed to the increase in the awareness of importance of oral health and increased accessibility to healthcare services. [27] Efforts by people have been observed to evade complete edentulism. This could be the reason for the younger age group approaching the OPD for the necessary treatment.

It was observed that more than half of the study population belonged to the medium income group, one-fourth of the patients belonged to the high income group and less than one-fourth of the patients belonged to the low income group. Only a small number of patients that approached the OPD for treatment belonged to the illiterate group and the majority belonged to the basic education group. It was determined that socio-economic status is negatively associated with edentulism, with those in lower levels exhibiting higher risks of becoming edentulous. [28],[29] Although, patients belonging to the illiteracy group have more number of missing teeth compared to the other groups, these people belong to socially disadvantaged groups in the society with lack of awareness and financial constraints being the main reason for their neglect. Majority of our study population belonged to the higher education group. This may be attributed to higher levels of income and awareness due to the media and peer group influence. Studies also indicate that patients belonging to the basic educational and low income levels avail of the resources at the public oral health centers. In addition, it was observed that patients belonging to the higher income levels approached private oral health clinicians. [30],[31] This explains the reducing number of highly educated people approaching the OPD. Another important observation was that a majority of the study population resided in urban areas. People living in developing countries, especially those living in rural areas, have less access to dental care services when compared to their urban dwelling counterparts. [5]

In regards to oral hygiene status, a majority of the individuals (54.35%) belonged to the fair group. Partially edentulous patients tend to have more plaque, suggesting a poorer oral health status. [32] This could be a direct reflection of low interest in oral health care causing subsequent total tooth-loss. Dental caries and periodontal disease are the two main risk factors for partial tooth loss. [32] This study noted a majority of the teeth lost to be molars which was in accordance with another study conducted by Broadbent et al, [33] since the caries experience was greatest in the molar teeth. The highest incidence of caries was noted in the mandibular first molar teeth, [33] since mandibular first molars are the first permanent teeth to erupt in the oral cavity.

Studies on self-perception of prosthodontic needs demonstrated that oral function and aesthetics are important elements in improving the quality of life. [34] It was observed that most of the patients had missing teeth in the posterior regions, indicating lack of function as the main reason for replacement of teeth. However, when patients had missing teeth in the anterior region along with missing teeth in the posterior region, their primary reason for replacement was aesthetics. [35]

It was also recorded that subjects preferred a fixed treatment option, over a removable option.

Since psychological factors are one of the main determinants for the need of dental treatment, most patients perceive fixed treatment to be more fulfilling as it simulates natural teeth. [36]

In this study, Kennedy's class III group was the most frequent type of partial edentulism. Majority of the patients presented with one to two missing teeth. It was also noted that the lower jaw was more affected than the upper jaw. This can be attributed to the high prevalence rate of dental caries in mandibular first molar teeth. [5],[33]

Limitations

The study was conducted in an institution-based set-up. A majority of the study participants were females. This might bias the study results, as the selected sample is not representative of the state population. Hence, any interpretation of the results of this study must bear this limitation in mind.

 CONCLUSION



This study clearly reveals that partial edentulism is dependent on a combination of socio-demographic factors. As outlined earlier, the rationale is to provide necessary data for planning and implementation of comprehensive programs to decrease the incidence and prevalence of partial edentulism in Goa. There is a definitive need for a step-by-step approach in eradicating the cause all-over the country with special focus on people who suffer from socio-economic and geographical disadvantage. Media is a powerful tool and can be employed to spread awareness about oral health care and motivate people from all socio-economic classes to take preventive measure against complete edentulism.

References

1Oral health information systems, World Health Organization. Available from: http://www.who.int/oral_health/action/information/surveillance/en/index1.html . [accessed on 2010 Aug 8].
2Shamdol Z, Ismail N, Hamzah N, Ismail A. Prevalence and Associated Factors of Edentulism among Elderly Muslims in Kota Bharu, Kelantan, Malaysia. JIMA 2008;40:143-8.
3Esan TA, Olusile AO, Akeredolu PA, Esan AO. Socio-demographic factors and edentulism: The Nigerian experience. BMC Oral Health 2004;4:3.
4Cnha-Cruz J, Hujoel PP, Nadanovsky P. Secular trends in socio-economic disparities in edentulism: USA, 1972-2001. J Dent Res 2007;86:131-6.
5Lin HC, Corbet EF, Lo EC, Zhang HG. Tooth loss, occluding pairs, and prosthetic status of Chinese adults. J Dent Res 2001;80:1491-5.
6Census population of India 2001. Available from: http://indiabudget.nic.in/es2006-07/chapt2007/tab97.pdf. [accessed on 2010 Aug 8].
7Area and population, Government of Goa. Available from: http://goagovt.nic.in/gag/arepop.htm. [accessed on 2010 Aug 8].
8Education, Government of Goa. Available from: http://goagovt.nic.in/gag/educ.htm. [accessed on 2010 Aug 8].
9Peter S. Survey Procedures. In: Peter S, editor. Essentials of Preventive And Community Dentistry, 2nd Edition. New Delhi: Arya (Medi) Publishing House; 2003. p. 616-44.
10Agarwal A. Social classification: The need to update in the present scenario. Indian J Commun Med 2008;33:50-1.
11Teófilo LT, Leles CR. Patients' self-perceived impacts and prosthodontic needs at the time and after tooth loss. Braz Dent J 2007;18:91-6.
12Shimazaki Y, Soh I, Saito T, Yamashita Y, Koga T, Miyazaki H, et al. Influence of dentition status on physical disability, mental impairment, and mortality in institutionalized elderly people. J Dent Res 2001;80:340-5.
13Johnson NW, Glick M, Mbuguye TN. (A2) Oral health and general health. Adv Dent Res 2006;19:118-21.
14Hutton B, Feine J, Morais J. Is there an association between edentulism and nutritional state? J Can Dent Assoc 2002;68:182-7.
15Geissler CA, Bates JF. The nutritional effects of tooth loss. Am J Clin Nutr 1984;39:478-89.
16Sheiham A, Steele J. Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older people? Public Health Nutr 2001;4:797-803.
17Prabhu N, Kumar S, D'souza M, Hegde V. Partial edentulousness in a rural population based on Kennedy's classification: An epidemiological study. J Indian Prosthod Soc 2009;9:18-23.
18Medina-Solís CE, Pérez-Núñez R, Maupomé G, Casanova-Rosado JF. Edentulism among Mexican adults aged 35 years and older and associated factors. Am J Public Health 2006;96:1578-81.
19Downer MC. The improving dental health of United Kingdom adults and prospects for the future. Br Dent J 1991;170:154-8.
20Hoover JN, McDermott RE. Edentulousness in patients attending a university dental clinic. J Can Dent Assoc 1989;55:139-40.
21Marcus PA, Joshi A, Jones JA, Morgano SM. Complete edentulism and denture use for elders in New England. J Prosthet Dent 1996;76:260-6.
22Grath CM, Bedi R, Gilthorpe MS. Oral health related quality of life-views of the public in the United Kingdom. Community Dent Health 2000;17:3-7.
23Marcus SE, Drury TF, Brown LJ, Zion GR. Tooth retention and tooth loss in the permanent dentition of adults: United States, 1988-1991. J Dent Res 1996;75:684-95.
24Brown LJ. Trends in tooth loss among U.S. employed adults from 1971 to 1985. J Am Dent Assoc 1994;125:533-40.
25Osterberg T, Carlsson GE, Sundh W, Fyhrlund A. Prognosis of and factors associated with dental status in the adult Swedish population, 1975-1989. Community Dent Oral Epidemiol 1995;23:232-6.
26Biazevic MG, Rissotto RR, Michel-Crosato E, Mendes LA, Mendes MO. Relationship between oral health and its impact on quality of life among adolescents. Braz Oral Res 2008;22:36-42.
27Löe H. Oral hygiene in the prevention of caries and periodontal disease. Int Dent J 2000;50:129-39.
28Iacopino AM, Wathen WF. Geriatric prosthodontics: An overview, Part I: Pretreatment considerations. Quintessence Int 1993;24:259-66.
29Iacopino AM, Wathen WF. Geriatric prosthodontics: An overview, Part II: Treatment considerations. Quintessence Int 1993;24:353-61.
30Palmqvist S, Söderfeldt B, Vigild M, Kihl J. Dental conditions in middle-aged and older people in Denmark and Sweden: A comparative study of the influence of socioeconomic and attitudinal factors. Acta Odontol Scand 2000;58:113-8.
31Shah N, Parkash H, Sunderam KR. Edentulousness, denture wear and denture needs of Indian elderly: A community-based study. J Oral Rehabil 2004;31:467-76.
32Burt BA, Ismail AI, Morrison EC, Beltran ED. Risk factors for tooth loss over a 28-year period. J Dent Res 1990;69:1126-30.
33Broadbent JM, Thomson WM, Poulton R. Progression of dental caries and tooth loss between the third and fourth decades of life: A birth cohort study. Caries Res 2006;40:459-65.
34Gilbert GH, Meng X, Duncan RP, Shelton BJ. Incidence of tooth loss and prosthodontic dental care: Effect on chewing difficulty onset, a component of oral health-related quality of life. J Am Geriatr Soc 2004;52:880-5.
35Elias AC, Sheiham A. The relationship between satisfaction with mouth and number and position of teeth. J Oral Rehabil 1998;25:649-61.
36Ettinger RL. Oral disease and its effect on the quality of life. Gerodontics 1987;3:103-6.