South wales

Tooth retention has been one of the main aims of oral care which in turn could have contributed
to the social oral health divide. To investigate this issue further, data collected for a group audit
was used to study the reasons for tooth extraction for patients attending for routine treatment at
four dental practices. The practices served populations in areas with different levels of
deprivation in South Wales. In 558 teeth extracted over 417 visits, the reasons for extractions
were: caries 59%, periodontal disease 29.1%, pre-prosthetic 1%, wisdom teeth 4.6%, orthodontic
5.5%, trauma 1.2%, patient request 2.4% and 6.2% other reason. The number of extraction visits
per day within the group of dental surgeons varied with three practitioners performing more than
three extraction visits per day while one practitioner had only 0.51. These reasons did not
significantly depend on levels of deprivation. However, significantly more teeth were extracted
for caries in the most deprived group in comparison to the least deprived. Therefore, could there
be a case for appropriate extractions in the quest for equitable care

Jepang

BACKGROUND: There has been no nationwide study in Japan on reasons for extraction of
permanent teeth. This survey was aimed to determine the reasons for extraction of permanent
teeth in Japan. METHODS: Five thousand, one hudred and thirty-one dentists were selected by
systematic selection from the 2004 membership directory of the Japan Dental Association. The
dentists selected were asked to record the reason for each extraction of permanent teeth during a
period of one week from February 1 through 7, 2005. Reasons for tooth extraction were assigned
to five groups: caries, fracture of teeth weakened by caries or endodontics, periodontal diseases,
orthodontics, and other reasons. RESULTS: A total of 2,001 dentists (response rate of 39.1%)
returned the questionnaires, and information on 9,115 extracted teeth from 7,499 patients was
obtained. The results showed that caries and its sequela (totally 43.3%, 32.7% and 10.6%,
respectively) and periodontal disease (41.8%) were the main reasons for teeth extraction.
Extraction due to caries or fracture was commonly observed in all age groups over 15 years of
age, whereas periodontal disease was predominant in the groups over 45 years of age.
CONCLUSIONS: Most of the permanent teeth were extracted due to caries and its sequela and
periodontal disease. Prevention and care for dental caries for all age groups and periodontal
disease for over middle age groups are require

Singapore

Abstract A survey was carried out to determine the reasons for tooth extractions of permanent
teeth in Singapore. Data were obtained from 52 dentists practising general dentistry over a period
of 12 months. At the end of the 12-month period, data were collected from 1276 patients, from
whom a total 272 teeth were extracted. In this population group, the results showed that the
percentage of teeth extracted due to periodontal reasons and caries were about the same, that is,
35.8% and 35.4%, respectively. There was an increase in teeth extracted due to periodontal
reasons with age. In patients above 40 yr, an average of 76% of teeth were lost due to periodontal
reasons. An average of 26.7% of teeth were lost due to periodontal reasons in patients under 40
yr old. However, the trend for loss of teeth due to caries is reversed. Posterior teeth were more
frequently extracted compared to anterior teeth. Third molars accounted for 24.7% of all
extractions carried out. whilst central incisors were 8.0% of all extractions. Molars were often
lost due to caries and lower anterior teeth were most frequently lost due to periodontal reasons.
The results of this study did not demonstrate one predominant reason for extraction. Both caries
and periodontal reasons were equally common causes of tooth extraction.

Kuwait

Objectives: To investigate reasons for tooth extraction and its association with age and gender in
Kuwait. Subjects and Methods: A record of all tooth extractions performed in 21 general dental
practice centers during a 1-month period was logged on specially designed study forms. The
patients age and gender, number of teeth extracted, and the reason(s) for the extraction were
recorded. Results: A total of 2,783 teeth were extracted in 1,604 patients (1.73 0.07 teeth per
patient). Caries and periodontal disease were responsible for 43.7 and 37.4% of extractions,
respectively. Caries was the principal cause for extraction in patients 40 years old (60.7%),
while periodontal disease was the main cause of extractions in patients 40 years of age (63.0%).
Extractions for caries and orthodontic reasons were more common in females, while extractions
for periodontal disease were more prevalent in males. Molars and maxillary premolars were
more commonly extracted due to caries, while mandibular premolars, and maxillary and
mandibular anterior teeth (canines and incisors) were more commonly extracted due to
periodontal disease. Conclusions: The data show that caries is the principal cause for extractions
in younger patients, while periodontal disease accounts for the majority of tooth extractions in
patients older than 40 years. Furthermore, this study indicates that more teeth per patient are lost
to periodontal disease than for any other reason

Kenya

Objective: To determine the causes and pattern of missing permanent teeth among Kenyans.

Design: A descriptive cross-sectional study.

Setting: Five districts in Kenya.

Subjects: Seven hundred and twenty two persons aged 6-85 years (346 males and 376 females).

Methods: This study was undertaken in October 2001 during the National Dental Health
Action Month organised by the Kenya Dental Association. Six centres in five districts

were identified and subjects randomly selected. Intra- oral examination was done visually

and results were recorded on specially designed clinical examination forms.

Results: The mean number of missing teeth in the population was 1.60. Among those

with missing teeth, the mean number of missing teeth was 3.35. The most commonly

missing teeth were lower molars followed by upper molars. No record of complete

edentulousness in both jaws was encountered. Dental caries was the commonest cause

of tooth loss (52.6%), followed by periodontal disease (27.6%). Extractions, as a form

of traditional practice, accounted for 12.3% of total tooth loss. Orthodontic treatment

and trauma accounted for 2.2% and 2.0% respectively of total tooth loss. The upper

and lower posteriors were the commonest teeth lost due to dental caries and periodontal

disease. Teeth lost due to trauma were mostly upper anteriors, whereas those extracted

due to traditional practices were exclusively lower anteriors.

Conclusion: The findings of this study show that the commonly lost teeth are molars

and the principal cause of tooth loss is dental caries followed by periodontal disease.

Overall, very few extractions had been done for orthodontic reasons.

Yamen
Pakistan

OBJECTIVE:
METHODOLOGY:
RESULTS:
CONCLUSION:
KEYWORDS:
The aimof this studywas to investigate the primary reasons for simple extraction of permanent teeth
inDental Section of a tertiary care hospital and to identify themost frequently extracted teeth.
The patients selected for this study were identified by reviewing dental notes from medical
records of patients who had undergone dental extraction at Dental clinic, at The Aga Khan University
Hospital,
Karachi. Total of 124 charts were reviewed retrospectively. Data regarding the age, gender, co morbid
conditions,
date of extraction, number and type of tooth extracted and the cause of exodontia were recorded in a
proforma.
Descriptive analysiswas done using SPSS version13.0.
Atotal of 147 teeth extracted from 77 patientswere included for analysis.Out of 77 patients, 56%were
females and 44% were males.Average age was 49.7 + 16 years. (11-83 years). Reasons for extraction
were: 42.2%

Tabris

Background and Objectives: Preservation of teeth and their supporting structure up to

elderly implies the high oral hygiene and also the efficacy of the health care system. On the
other hand early extraction of teeth especially when done because of financial issues is
unfavorable and is a manifestation of a deficient oral care system and a lack of oral hygiene
knowledge. The aim of this study is to assess reasons for tooth extraction and their prevalence
in Tabriz dental faculty.
Methods and Materials: In a cross-sectional and descriptive survey, general information, the
causes and rate of tooth extraction and the oral hygiene status of patients referring to
department of Oral & Maxillofacial surgery in Tabriz University of Medical Sciences were
assesses. Data were analyzed with Chi-Square test using SPSS software for any statistical
differences between tooth extraction reasons and other studied variable (such as educational
status).
Results: 900 teeth were extracted. Unrestorable tooth tissue loss (40.5%), prosthetic problems
(35.6%) and periodontal diseases (15.1 %) were the most prevalent reasons for the extraction.
Mandibular first molar was the most extracted tooth (17.52%). The extraction rate had a reverse
and statistically significant relation with the oral hygiene and educational status (P<0.05).
Conclusion: caries, pre-prosthetic reasons and periodontal problems were the most prevalent
reasons for extraction. According to the result, it seems that with oral hygiene instruction and
promotion and by early prevention we can prevent the most prevalent causes of tooth loss.
France

3516 French dentists, selected at random, were asked to record every tooth they extracted during
January, 1984. They were also asked to give the reason for extraction in each case. These were
assigned to eight groups: caries, periodontal diseases, eruption problems, prosthetics, trauma,
orthodontics, occlusal problems, and other reasons. Data were received from 910 dentists
(25.3%) relating to a total of 14,621 extractions. Overall, caries was the most frequent cause for
extraction (49%), followed by periodontal diseases (32.4%) and orthodontics (8.4%). In the age
group under 50, dental caries was the main reason for extraction. However, in the age group
over 50, periodontal diseases became the principal reason for extraction. Orthodontic
extractions were most prominent in the 6-12 and 13-20 age groups, with respective frequencies
of 72.6% and 24.8% of all extractions. Eruption problems contributed most frequently in the 13-
20 and 21-30 age groups, their respective percentages being 8.7% and 12.3%. Extractions
resulting from trauma were most frequently noted in the under-6 age group (frequency of 8.8%).
As far as the type of tooth was concerned, first and second molars taken together made up
29.6% of extractions These were followed by pre-molars, anterior teeth, and third molars at
levels of 25.8%, 29.9%, and 14.7%, respectively.
The teeth most frequently extracted because of caries were the molars (40.9%); because of
periodontal disease, the anteriors (49.1%); and, for prosthetic reasons, again the anteriors
(57.5%). Extractions from the various regions of France showed important variations.
Percentage frequencies for caries and periodontal extractions were inversely linked

Scotland

OBJECTIVES:

A 1984 study investigated the reasons underlying the extraction of teeth in Scotland. The survey
described in this paper, used a similar methodology and aimed to determine the reasons for the extraction
of permanent teeth by general dental practitioners and investigate changes in the influences on tooth
extraction over a 10 year period.

METHODS:

During a 1 week period in November 1994, 139 general dental practitioners working throughout Scotland,
recorded the reasons for all permanent tooth extractions.

RESULTS:

A total of 917 permanent teeth were extracted from 613 patients, the reason for extraction being stated as
dental caries (51%), periodontal disease (21%), orthodontics (11%) and failed endodontics (4%). Trauma,
pericoronitis and other reasons accounted for 5.5% of extractions whilst, in 7.5% of cases, patients
requested extraction in preference to other treatments. The proportion of extractions attributed to
periodontal disease increased from age 31-60 years, but declined thereafter.
CONCLUSIONS:

Comparing the results with those obtained in the 1984 study, whilst the mean number of teeth extracted
by each practitioner had reduced, the overall relative contribution of different reasons for extraction was
similar

Nigeria

Frequency Distribution of Tooth Loss due to Caries According to Tooth Type

A total of 1269 patients attended the clinic, 8741 patients under went extraction, 11546 teeth were
extracted altogether
and 6145 permanent teeth were extracted due to caries and its sequalae within the two years under
review
periodontitis

the most frequently reported reasons to indicate the

extraction of teeth with periodontitis were the presence of
mobility (37.5%), severity of attachment loss (24.3%) and
radiographic bone loss greater than 50% (21.2%), followed
by socioeconomic and cultural aspects (16.4%), prosthetic
planning (12.5%) and furcation involvement (5.3%). Reasons
such as presence of extensive caries (3.3%), possibility of
systemic involvement due to periodontitis (3.3%) and
periodontal-endodontic lesions (2.0%) were the least
mentioned among the reasons for tooth extraction (Table 2).
Figure 1 presents the reasons mentioned for tooth extraction,
with stratification according to the year of graduation.

Understanding the pattern and the causes for tooth

loss in a population is important for development of
dental health services. Surveys to determine the reasons
for tooth extraction have been carried out in many
countries. Most of these surveys were similar as they
investigated the amount of tooth loss, the reasons
behind extraction, and the distribution of tooth loss
according to age, gender and tooth type

Reasons for tooth extraction have large geographical

and cultural differences between countries. Even
though periodontal disease was found to be the most
frequent reason for tooth extraction in Germany and
Canada 9, 10, the proportions of caries and periodontal
disease are almost the same in Italy and Singapore.7, 11
upernumerary teeth are teeth in excess of the normal
number. The prevalence of hyperdontia is reportedly
between 0.15% and 3.9%.15 Extra teeth may present
in both the permanent and the primary dentitions but are
5 times less frequent in the primary dentition.6,7,8 A
mesiodens is a supernumerary tooth located in the maxillary
central incisor region; the overall prevalence of mesiodentes
is between 0.15% and 1.9%.79 Mesiodens can occur individually
or as multiples (mesiodentes), may appear unilaterally
or bilaterally, and often do not erupt.9 Mesiodentes can
significantly alter both occlusion and appearance by altering
the eruption path and the position of the permanent
incisors.911 This paper outlines the causes and modes of
presentation of mesiodentes and discusses their diagnosis and
management. Whether there are one or multiple supernumerary
teeth, management and treatment are the same.
Extraction of a supplementary mesiodens in the primary
dentition is usually not recommended because supernumerary
primary teeth often erupt into the oral cavity and
surgical extraction of unerupted teeth may increase the risk
of displacing or damaging the developing permanent
incisors.3436 However, extraction during the early mixed
dentition stage allows normal eruptive forces to promote
spontaneous eruption of the permanent central incisors
after the extraction.31,35,37

Prevalence/Prevalence Rates
Definition of Prevalence Rate
Some feel that prevalence is more a proportion than it is a rate.
Dissimilar to incidence, those individuals having already had the
disease do not need to be removed from the denominator. So,
mathematically, prevalence is a proportion (ranging from 0 to 1 or 0
to 100 percent).
In epidemiology, prevalence rates are generally found in the
following:
- Cross-sectional studies
- Disease register studies
7
We will discuss the following 3 types of prevalence rates:
1) Point prevalence rate
2) Period prevalence rate
3) Lifetime prevalence rate
Point Prevalence Rate
The point prevalence rate represents all instances of a disease in a
particular location at a particular point in time.
Point Prevalence = Every instance of the investigated disease at
Rate a particular time
"At risk" population at the same particular
time
** Recall, the resulting value will range from 0 to 1 (or 0 to 100
percent).
A disadvantage to this method is that it does not always consider the
disease in a way that is helpful to organizations that consider longerterm
effects.
Period Prevalence Rate
Period prevalence attempts to overcome the pitfalls of prevalence
studies taken at a single point in time. All instances, whether new, old
or recurring, are counted over a specified period.
Period Prevalence = Every instance of the investigated disease
Rate within a defined time period
Average "at risk" population during the time
period
Period prevalence is a combination of the ideas of incidence and point
prevalence, and can be helpful in investigating recurring diseases (e.g.
depression). Each of incidence and point prevalence on their own
have a tendency to negatively misjudge the import of such issues,
making a combination of the two a better estimate.
8
Lifetime Prevalence
Lifetime prevalence is a superior expansion on the concept of period
prevalence. It is a representation of the proportion of the population
that have ever had the disease.
Lifetime Prevalence = Number of individuals having ever
had the disease during their lifetime
"At risk" population (from beginning
of time period)
The majority of information for lifetime prevalence rates is generally
collected from birth cohort studies, where individuals are followed
from birth. Measures of lifetime prevalence usually permit one to see
the commonality of particular diseases in the frequency of their
occurrence (e.g. the proportion of the population ever having had
asthma could be measured at the age of 5, 10, 15, 30, 45, etc. years,
until death