|DENTAL SCIENCE - ORIGINAL ARTICLE
|Year : 2015 | Volume
| Issue : 6 | Page : 643-647
Prevalence of partial edentulousness among the patients reporting to the Department of Prosthodontics Sri Ramachandra University Chennai, India: An epidemiological study
Seenivasan Madhankumar, Kasim Mohamed, Shanmuganathan Natarajan, V Anand Kumar, I Athiban, TV Padmanabhan
Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
|Date of Submission||28-Apr-2015|
|Date of Decision||28-Apr-2015|
|Date of Acceptance||22-May-2015|
|Date of Web Publication||1-Sep-2015|
Dr. Seenivasan Madhankumar
Department of Prosthodontics, Faculty of Dental Sciences, Sri Ramachandra University, Porur, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aims and Objectives: To determine the occurrence of various missing teeth pattern among the partial edentulous patients residing in Chennai who are undergoing treatment for the replacement of missing teeth in the Department of Prosthodontics, Sri Ramachandra University Chennai, India. Settings and Design: Study was undertaken from January 2014 to October 2014, and the design was a descriptive cross-sectional study. Materials and Methods: Five hundred and sixty-one persons aged between 13 and 87 years (267 males and 294 females) were selected, intraoral examination was done visually and results were recorded on specially designed clinical examination forms. Statistical Analysis: Data were analyzed using statistics SPSS 19.0 version (IBM India Private Limited Bangalore) to investigate the relationship between quantitative variables. Results: The results showed the patients with Kennedy's Class III were found to be the most prevalent among all the groups (55%). The most common modification in all the groups was Class III modification I (26%). It was also found that Kennedy's Class III was founded more in the age group of 31-40 with 54.4% in the maxillary arch and 47.2% in the mandibular arch. Conclusion: The findings of this study show that the Kennedy's Class III was the most commonly occurring and were found to be more predominant in the younger group of population.
Keywords: Gender, Kennedy′s classification, missing tooth, partial edentulousness
|How to cite this article:|
Madhankumar S, Mohamed K, Natarajan S, Kumar V A, Athiban I, Padmanabhan T V. Prevalence of partial edentulousness among the patients reporting to the Department of Prosthodontics Sri Ramachandra University Chennai, India: An epidemiological study. J Pharm Bioall Sci 2015;7, Suppl S2:643-7
|How to cite this URL:|
Madhankumar S, Mohamed K, Natarajan S, Kumar V A, Athiban I, Padmanabhan T V. Prevalence of partial edentulousness among the patients reporting to the Department of Prosthodontics Sri Ramachandra University Chennai, India: An epidemiological study. J Pharm Bioall Sci [serial online] 2015 [cited 2019 Dec 10];7, Suppl S2:643-7. Available from: http://www.jpbsonline.org/text.asp?2015/7/6/643/163580
Tooth loss has an impact on an individual's oral health-related quality of life at biologic, psychological, and social levels. The prevalence and extent of tooth loss have decreased significantly in many countries during recent decades. ,, There still remains a significant variation in tooth loss distribution.  These disparities may be attributed partly to the increased availability and accessibility to oral diseases prevention and control programs, as well as to increase in the awareness of the importance in oral health. The study of trends in tooth loss, comparing rate of occurrence between different populations, may provide important information about risk factors for tooth loss, potential changes in oral health status, and possible causes of these changes.
Tooth loss is identified by an edentulous space, which is a gap in the dental arch normally occupied by one tooth or more. It could be partial or complete. A person may lack a few teeth (partially edentulous) or all the teeth in one or both upper and lower jaws (completely edentulous) for various reasons. Bruce observed that the major reason for tooth loss across all the ages were due to dental caries (83%) followed by periodontal disease (17%).  A simple estimate of the percentage of partially edentulous persons is a rough indication of the frequency of dental diseases and the success or failure of dental care. Observance of a pattern of tooth loss determines the treatment requirement among the population. The design of the prosthesis depends on the type of saddle area. A classification of partially edentulous arches helps to identify the relation of remaining teeth to edentulous ridges and facilitates communication, discussion, and comprehension of the suggested prosthetic treatment among dentists, students, and technicians.
Pattern of tooth loss is a clear indicator of levels of oral hygiene, dental health awareness, the magnitude of dental problems, and the management. Epidemiological studies related to the status of a pattern of tooth loss are scarce in India especially in South India. Owing to the large Indian population, a nationwide survey cannot be done. However, the epidemiological features of partial edentulousness of one community can be assessed on the basis of a cross-sectional study. The present study was done in order to provide complete reflection of dental status and treatment needs which would be of valuable information to the National Oral Health Planners for laying out strategies to develop dental health care management in the country. Learning the truth that tooth loss and its effects are so detrimental, our study aimed to find:
- The incidence of Kennedy's classification among the partially edentulous subjects based on gender ratio and age-wise distributions
- Predominance of which type of Kennedy's classification among the patients attending the selected dental clinics in Chennai for replacement of their missing teeth.
| Materials and Methods|| |
This study was carried out from January 2014 to October 2014 among patients reporting to the Department of Prosthodontics Sri Ramachandra University, Chennai for replacement of their missing teeth, India. Convenience sampling technique was utilized for data collection, and 561 patients were selected. The inclusion criteria involved both the genders, aged between 13 years and 87 years having partially edentulous areas in either or both the jaws. Completely edentulous patient and those with only missing maxillary and mandibular third molars were excluded from the study. The study population were divided into two clusters, comprised 267 men and 294 women. The selected patients were grouped according to their age [Table 1]. Pretested proforma was used, which includes name, age, gender, and details of missing permanent teeth.
Clinical examination of each patient was carried out after obtaining consent, and intraoral examination was done using a mouth mirror, probe in satisfactory lighting, and direct visual examination. No diagnostic aids like study models or radiographs were used in this survey. The patterns of missing teeth were identified according to the Kennedy's classification. The number of teeth was defined as healthy, carious or treated teeth (including crowned, inlay, and abutment teeth for fixed partial prosthesis), inclusive of completely erupted third molars. Un-erupted or congenitally missing teeth, root tips, and very loose teeth that were indicated for extraction were not included as remaining teeth and were excluded from the study. Data analysis was carried out by using IBM SPSS 19.0 version, (IBM India Private Limited, Bangalore) to estimate the percentage of predominately occurring Kennedy's classification within the genders and also according to the age.
| Results|| |
Data were analyzed by using IBM SPSS 19.0 version, the Pearson Chi-square analysis test was conducted and P < 0.05 was considered to be statistically significant. The survey included 561 patients, of 267 (47.5%) male patients and 294 (52.5%) female patients aged between 13 and 87 years having partially edentulous areas in either or both the jaws. [Table 2] and [Table 3] show the incidence of different patterns of partial edentulism according to Kennedy's classification for male and female, respectively. The results showed the occurrence of Class III partial edentulism with 56.57% in maxillary and 46.96% in mandibular arch for a male patient. Similarly, Class III type of partial edentulism was also found in a female patient with 52.40% in maxillary and 47.23% in the mandibular arch. This was followed by Class III modification I in both the genders with an average of 30.83% in male patient and 27.01% in female patient. Based on these results, patients with Kennedy's Class III were found to be the most prevalent among both the genders (54.41%) in the maxillary arch and (47.11%) in the mandibular arch, and the most common modification was Class III modification I among both the genders (25.96%) in the maxillary arch and (31.17%) in the mandibular arch.
|Table 2: Partial edentulous male subjects classified according to Kennedy's classification for the maxillary arch and the mandibular arch|
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|Table 3: Partial edentulous female subjects classified according to Kennedy's classification for the maxillary arch and the mandibular arch|
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[Table 4] and [Table 5] show Kennedy classification for age-wise variation for maxillary and mandibular arch. The result showed Class III predominance between 13 and 69 years in both arches while Class II modification I was found in the maxillary arch of age group 70-85 years. The next predominant classification was Class III modification I for all ages in both the arch except for 50-59 years age group had Class II modification I in the mandibular arch. Among the different age group, the predominance of Class III was found in 31-40 years. In this regard Chi-squared test was conducted to analyze whether there is any correlation when compared between the genders and also the age with respect to Kennedy's classifications in maxillary and the mandibular arch, and it was found that there was no association when compared between the male and female patients for maxillary arch and mandibular arch [Table 6]. It was also found that there is a significant difference in the age-wise comparison of the group in both in the maxillary arch and the mandibular arch [Table 7].
|Table 4: The age-wise distribution of the various classes Kennedy's classifications in the maxillary arch|
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|Table 5: The age-wise distribution of various classes Kennedy's classifications in the mandibular arch|
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|Table 6: Association between the genders and various classes of partial edentulousness in the maxillary and mandibular arch|
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|Table 7: Association between the age and various classes of partial edentulousness in the maxillary and mandibular arch|
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| Discussion|| |
It is increasingly recognized that the impact of the disease on quality of life should be taken into account when assessing health status. It is likely that tooth loss, in most cases being a consequence of oral diseases, which affects the oral health-related quality of life (OHRQoL).  In a large Japanese study, Ide et al. found a strong correlation between the number of missing teeth and higher oral health impact profile scores suggesting impairment of OHRQoL.  Edentulous falls into a special category among the various disease of dental origin. Tooth loss is the dental equivalent to mortality. A simple estimation of the proportion of the partial edentulous case is a rough indication of the prevalence of dental diseases and the success or failure of dental care. 
The prevalence of the partial edentulous adults in Iasi was 66.5% and was estimated that the rate of tooth loss was higher in the rural area, and more number of missing teeth were found in the male population.  In contrary to the above statement, this study showed that more number of missing teeth was seen in the female population.
The results of the present study indicate that the frequency of mandibular edentulous was higher than maxillary edentulism among the study population. Kennedy's Class III was found to be the most common pattern of partial edentulism among all the age groups both in the maxillary arch and the mandibular arch except in 70-87 years in which Class II modification I was predominant in mandibular arch. The present study was partially in accordance with Curtis et al.  wherein Kennedy's Class III was predominant only in the maxillary arches, while in mandibular arches the most prevalent pattern in the previous study was Kennedy's Class I. A major disparity between the two studies is that of the age factor, as the age group of Curtis' study was averaging 55 years whereas in this study the average age of the patients was 36.5 years.
Al-Dwairi  in a study investigated the frequency of different patterns of partial edentulism of 200 patients in Jordan and found that 150 had both maxillary and mandibular partial edentulism. In the present study, 9 different patterns were identified, in which Kennedy class III pattern of edentulism was the most commonly encountered in both the maxilla (54.5%) and mandible (47%) arches, and Kennedy Class III modification was the next most found from the result. This study also correlates with the study carried out on a Saudi population conducted by Sadig and Idowa  examining 422 partially dentate arches; Kennedy's Class III was the most commonly encountered pattern of partial edentulism in both the upper and lower arches and Kennedy's Class IV was the least common pattern encountered.
The findings of the present study suggesting a predominance of Class III pattern of partial edentulism may be due to the fact that a higher frequency of younger age groups was encountered whereas higher frequency of older population was seen in previous studies. The present study also shows increased awareness among the younger population with large number of younger groups reporting to the prosthodontics department for replacing the missing tooth. The higher frequency of partial edentulism in these younger age group patients, as depicted by the results, might pertain to their low socioeconomic status; poor oral hygiene and less conservative treatment approach, relating to lack of time, leading to early tooth loss.
The data obtained from present study on the frequency and distribution of tooth loss are very important to provide the practitioners with the information needed to address various factors implicated in tooth loss, to reduce its mortality and also to educate and to motivate patients on the importance of saving tooth. At the national level, these data also suggest that preventive strategies aimed at reducing tooth loss need to be reinforced. Peterson and Yamamoto  reported that oral diseases and chronic diseases share common risk factors. Hence, the National Health Programs should incorporate disease prevention and health promotion measures using a common risk factor approach in combination with the strategies to prevent tooth loss which need an urgent attention by the policy makers for old people.
| Conclusion|| |
The present epidemiological study reported the prevalence of missing tooth in different age group and gender which showed existence of Class III followed by Class III modification I which were predominant among younger population of 31-40 years, while in geriatric population between 70 and 85 years Class II modification I was present. Comprehensive information on tooth loss is required to form a generalized database for the partial edentulism patterns, which will help us in the identification of the causes of such tooth loss and its prevention. There are possible limitations in this study as the following factors were not evaluated. The cause of the tooth loss, the literacy level, and the socioeconomic status were not evaluated to identify the reason for tooth loss, chronology for tooth loss, and radiographs were not used to identify congenitally missing and impacted teeth.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Okosioe FE. Tooth mortality: A clinical study of the causes of tooth loss. Niger Med J 1977;7:77-81.
Odusanya SA. Tooth loss among Nigerians: Causes and pattern of mortality. Int J Oral Maxillofac Surg 1987;16:184-9.
Kaimenyi JT, Sachdera P, Patel S. Causes of tooth mortality at the dental hospital unit of Kenyatta National Hospital, Kenya. J Odontostomatol Trop 1998;1:17-20.
Sadig WM, Idowu AT. Removable partial denture design: A study of a selected population in Saudi Arabia. J Contemp Dent Pract 2002;3:40-53.
Bruce I, Nyako EA, Adobo J. Dental service utilisation at the Korle Bu Teaching Hospital. Afr Oral Health Sci J 2001;3:64-7.
Gerritsen AE, Allen PF, Witter DJ, Bronkhorst EM, Creugers NH. Tooth loss and oral health-related quality of life: A systematic review and meta-analysis. Health Qual Life Outcomes 2010;8:126.
Ide R, Yamamoto R, Mizoue T. The Japanese version of the Oral Health Impact Profile (OHIP) - Validation among young and middle-aged adults. Community Dent Health 2006;23:158-63.
Prabhu N, Kumar S, D'souza M, Hegde V. Partial edentulous in a rural population based on Kennedy's classification: An epidemiological study. J Indian Prosthodont Soc 2009;9:18-23.
Murariu A, Hanganu CS, Danila I. Prevalence of missing teeth and the treatment need in adult population from Iasi, Romania. Int poster J Dent Oral Med 2010;12:Poster 490.
Curtis DA, Curtis TA, Wagnild GW, Finzen FC. Incidence of various classes of removable partial dentures. J Prosthet Dent 1992;67:664-7.
AL-Dwairi ZN. Partial edentulism and removable denture construction: A frequency study in Jordanians. Eur J Prosthodont Restor Dent 2006;14:13-7.
Petersen PE, Yamamoto T. Improving the oral health of older people: The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2005;33:81-92.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]