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Reasons for tooth loss, Riyadh city, 1996

The Field Epidemiology Training Program (FETP) conducted a survey from 29 June to 18 July, 1996 in Riyadh to determine the incidence of loss of permanent teeth in adolescent and adult Saudi nationals residing in Riyadh city. A representative probability sample of MOH and private dental clinics was selected. Clinics tabulated all dental consultations by Saudi nationals for a three week period. For a patient with any dental problem potentially treatable by tooth extraction a self-administered questionnaire was completed by the dentist and by the patient.
According to the survey results, an estimated 445,536 patients visited MOH and private dental clinics in Riyadh city in 1996. Of these consultations only 84,168 (19 %) were for preventive (periodontal) procedures while 285,516 (64%) were for restorative work and 22,680 (5.1%) were for extraction. Extractions accounted for an estimated 2112 (2.2%) of 100,195 dental consultations to private clinics compared to 16,877 (5.7%) of 297,101 consultations to MOH dental clinics and 5112 (7.6%) of 75,528 consultations to dental units in MOH hospitals. Of all teeth extracted for dental disease, 44% were removed because of caries alone, 21% because of periodontal (gum) disease alone and 35% because of both caries and periodontal disease. Periodontal disease contributed to an increasing share of extracted teeth as age increased from 28% of extractions for the age group i5 to 29 years to 81% for ages above 44 years.
Dentists provided their opinions about whether a tooth was potentially treatable by extraction. Among patients seen during the survey days, they extracted 10% of teeth that were potentially treatable by extraction and 90% were treated more conservatively. However, this extraction rate was lower in private clinics (4.4%) than in MOH facilities (10%). MOH clinics served a population of a lower social class than private clinics. Of MOH patients treated by tooth extraction, 23% were illiterate and 24% had completed secondary school. In comparison, only 6% of private clinic patients were illiterate and 71% had completed secondary school.

Editorial note:

Dental extraction or tooth loss is the end result of dental and periodontal disease that develops over the lifetime of the patient. Extraction or other loss of permanent teeth and in particular in younger age groups are important and measurable targets for prevention. In particular the substantial number of extractions in the under 45 year age group needs to be targeted for decrease. Preventive efforts will be particularly important in MOH clinics which see more patients for tooth extraction and serve a greater proportion of the lower socioeconomic classes. Systematic monitoring (surveillance) of tooth extractions with statistics reported back to dentists will allow dentists to gauge the effectiveness of their preventive efforts.
Tooth loss may be prevented through personal dental hygiene supported by periodic (biannual) visits to the dental clinic for dental hygiene and for early detection of caries and periodontal disease. This survey illustrates the extremely low utilization of both public and private dental clinics for preventive examinations and procedures. The ideal number of consultations for preventive (periodontal) procedures in one year should exceed the population of Riyadh city, but in actuality amounted to only 84,168 consultations. Not only is it important for dentists to concentrate more on providing preventive services among their patient populations, the public also needs to be made aware of the benefits of dental hygiene and preventive dentistry.