Exploring the practice of common oral diseases among the patients visiting in the selected dental college and hospital in Bangladesh

Khalid Hasan Pasha,Md.Fazlul Karim,Md.Mahmudur Rahman,Ashek Elahi Noor,Md.Mamunur Rashid,Nahid Al Nomann,Kazi Golam Mohiuddin

1Department of Oral&Maxillofacial Surgery,Sapporo Dental College and Hospital,Dhaka-1230,Bangladesh.2Department of Microbiology,Kumudini Women’s Medical College, Mirzapur, Tangail-1900, Bangladesh.3Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka-1312, Bangladesh.4Department of Dental Public Health, Sapporo Dental College and Hospital, Dhaka-1230, Bangladesh.5New Labaid Diagnostic Center & Hospital,Brahmanbaria-3400, Bangladesh.6Department of Science of Dental Materials, Sapporo Dental College and Hospital,Dhaka-1230,Bangladesh.7Department of Oral&Maxillofacial Surgery,Sapporo Dental College and Hospital,Dhaka-1230,Bangladesh.

Abstract Background: Having the ability to identify potential health risk factors such as lifestyle,ethnicity, health status, and social determinants associated with oral health status risk,health care providers can take an active role in health screening to discover any need for clinical preventive services, including dental preventive services, and can detect health problems. Methods: A descriptive type of cross-sectional study was conducted to explore the practice of common oral diseases among the patients visiting in the selected dental college and hospital in Bangladesh from October 2019 to December 2019.About 100 patients were interviewed through a semi-structured questionnaire, followed by an oral examination through a checklist and a face-to-face interview.A systematically random sampling technique was employed to select the study population.Results:Among them,the(21–30) year age group shows a maximum 20%, whereas the (71–80) year age group represents the minority with only 2%.Among them, 56% were male and 44% were female.Students represent the majority of 26%, whereas others (day laborers) represent only 4%.Decayed teeth remained in 72%of cases,teeth were missing in 31%of cases,and filled teeth were present in 24% of cases.A majority of 71% clean teeth once daily, whereas only 29%clean teeth twice daily.Again, only 30% brush teeth at night and a maximum of 95% brush teeth in the morning.Moreover, a maximum of 68% use toothpaste and brushes,while only 4% use meswak for cleaning their teeth.About 4% of cases with no debris, 51% of cases with less than 1/3rd of the tooth with debris,32%of cases with 1/3rd–2/3rd of the tooth with debris,and 13% of cases with more than 2/3rd of the tooth with debris were present.Again,about 30% had no calculus, 52% less than 1/3rd of tooth, 16% in between 1/3rd and 2/3rd of tooth, and 2% more than 2/3rd of the calculus was present.About 47% of mild, 22% of moderate, 6% of severe and 25% had no inflammation.Furthermore, for treatment purposes, 20.69% was advised for scaling, 19.66% for filling, 16.90% for root canal treatment, 17.59% for extraction, 17.24% for prosthodontic treatment, 1.03% for orthodontic treatment, 2.07% for pulpotomy, 2.41% for pulpectomy, and 2.41% for minor surgery.Overall, about 72% of the respondents, mostly the students, are suffering from decayed teeth,which may be due to a lack of frequency of brushing,indicating 95%that it is once daily.In addition, the most alarming situation among them is about 20.69% required scaling, which may be due to improper and inadequate brushing maintenance. Conclusion:to some extent, the above scenario may reflect the negative hallmark for our country’s younger generation in terms of oral health practice.Therefore, the establishment of a preventive oral health policy by our policymakers for the general population, mostly school-going students, on an emergency basis.

Keywords: dental caries; abscess; broken down root; broken down crown; decayed missing filled tooth; root canal treatment; orthopentomogram; intra oral periapical; cone beam computed tomography; body mass index

Introduction

Dental caries is a major dental public health problem around the world community though it can easily be preventable and treatable.But unfortunately, due to a lack of awareness and negligence on proper oral health care among the general population, the situation is worsening day by day all over the world, ultimately affecting the overall general and oral health of the people.

According to WHO report 15 March 2022, “it is estimated that oral diseases affect nearly 3.5 billion people.Untreated dental caries(tooth decay) in permanent teeth is the most common health condition according to the global burden of disease 2019”.

Moreover, more than 530 million children suffer from dental caries of primary teeth(milk teeth).Severe periodontal(gum)disease,which may result in tooth loss, is also very common, affecting almost 10% of the global population.Oral cancer (cancer of the lip or mouth) is one of the three most common cancers in some countries of Asia and the Pacific.

Treatment for oral health conditions is expensive and usually not part of universal health coverage.In most high-income countries,dental treatment averages 5% of total health expenditure and 20% of out-of-pocket health expenditure.Most low- and middle-income countries cannot provide services to prevent and treat oral health conditions.Factors contributing to oral diseases are an unhealthy diet high in sugar, tobacco use, and harmful use of alcohol.Most oral health conditions are largely preventable and can be treated in their early stages[1].

In Bangladesh, more than 20 million people were densely residing in a congested area having more than 80 percent of the population having at least one or more oral and dental diseases.Many suffer from periodontitis, gingivitis, dental caries, pulpitis, alveolar abscess, etc.[2].Furthermore, dental caries has been defined as a dietary“carbohydrate-modified bacterial infectious disease” [3].In addition,when it comes to dental health and socio-economic status have been recognized as the main factor for inequality[4].

In children, important social risk indicators are low socio-economic status and immigrant background, which indirectly influence oral hygiene standards and attitudes to dental care (Wendt et al., 1994;Hjern et al., 2001; Källestal and Wall, 2002) [5].

Astrøm & Jakobsen (1996) and Astrøm (1998) have studied the parents’ function as role models for their offspring into adolescence.These studies showed that the family is an essential mediator of socialization and the development of health-related behaviors even during adolescence.Nicolau et al.(2007) discussed a life-course approach and stated, “the development of oral hygiene habits may be sensitive to the socio-economic environment in which the people live during their childhood” [6].

Studies have also shown a relationship between the consumption of sugar-sweetened drinks and childhood obesity [7].

Although the etiological mechanisms, risk inhibitors and risk indicators for dental caries are well known, the early life events that may contribute to caries are not completely understood.Good oral hygiene habits established at an early age and maintained during pre-school age, appear to be essential to achieve good oral health in infants and pre- schoolchildren.However, very little information is available about the maintenance of good oral health factors over time,from early childhood to adolescence, and its effect on caries development later in life[8].

The purpose of the study was to explore the practice of common oral diseases among the patients visiting in the selected dental college and hospital in Bangladesh.

Method

A descriptive type of cross-sectional study was performed to explore the practice of common oral diseases among the patients visiting in the selected dental college and hospital in Bangladesh.The data were gathered through face-to-face interviews with patients using a semi-structured questionnaire.The investigation was determined by taking the history and oral examination using examination instruments such as a dental mirror, caries probe, periodontal probe and radio graphs.The important variables were considered and analyzed to fulfill the objectives of the study.The results were arranged in tabular form and explained according to the findings.A systematically random sampling technique was employed to select the study participants.The sample size was 100.The sampling was done by taking every 5th patient.To generalize the findings obtained from the sample to the total population,simple random sampling was used.A sampling frame was made; samples were then selected by lottery.The study period was three months (October to December 2019).Using the questionnaire, data were collected through face-to-face interviews with the respondents.Before filling out the questionnaire,the purpose of the study was explained very clearly to the respondents.The data collection instrument was a semi-structured questionnaire consisting of both open-ended and closed-ended questions.The interview questionnaires were checked for completeness and correctness before data entry.After coding,the data was entered into a master sheet in Microsoft Excel Excel and then exported to International Business Machines Corporation– Statistical Package for the Social Sciences version 20 for statistical analysis(Statistical Package for the Social Sciences) software.The data were checked and edited properly before analysis.The frequency distribution and proportion of important variables were also calculated.Ethical permission from the SUB proposal committee and pertinent members of the union was obtained.Informed consent from the respondent and the right to withdraw the consent were strictly maintained.The social and cultural beliefs of the respondents were followed.

Results

This cross-sectional study was initiated to characterize the socio-demographic, oral health behaviors and practices.This part includes the research methodology that is applied to explore the practice of common oral diseases among the patients visiting in the selected dental college and hospital named Sapporo Dental College and Hospital, Uttara, Dhaka in Bangladesh.The research design,population, place of the study, instrumentation, sampling procedure,data collection, and data analysis methods were also discussed.A systematically random sampling technique was employed to select the study participants.The sample size was 100.The sampling was done by taking every 5thpatient.

Discussion

A descriptive type of cross-sectional study was initiated to explore the practice of behavior-oriented treatment of common oral diseases among the patients visiting the selected tertiary dental college and hospital in Dhaka city.Among all the respondent groups, the (21–30)year age group represents a maximum of about 20%, whereas the(71–80) year age group represents the minority, measuring only 2%.On the other hand, a dissimilar finding in the study conducted by the NIH (National Institute of Dental and Craniofacial Research) reveals that about 92% of adults aged 20 to 64 have had dental caries in their permanent teeth, and white adults and those living in families with higher incomes and more education have had more decay.Moreover,a similar finding was found in the case of gender distribution, which was 90.57% in the case of males and in our study, it was 56% [9].

Again, among the respondents, students represent the majority,approximately 26%, service holders represent 22% and others (day laborers) represent only 4%.According to the study of the National Library of Medicine (National Center for Biotechnology Information),transport workers (45.5%) and managerial workers (40%) had decayed teeth.The majority of students visiting our hospital may be an alarming sign of the urgent need for stakeholders to implement preventive oral health policies[10].

Figure 1 Socio-demographic characteristics of the participant (n=100).Among all participant groups,the(21–30)year age group represents the maximum 20%,whereas the(70–80)year age group represents the minority of about 2%.Among them, 56% were male and 44% were female.Again, students represent the majority, approximately 26%, whereas others(day laborers) represent only 4%.

Figure 2 Oral health behavior of the participants(n=100).Among all the participants,decayed teeth remained in 72%of cases,teeth missing in 31% of cases, filled teeth in 24% of cases, abscess was 42% of cases, broken down root was 24% of cases, broken down root was 20% of cases.About 71% clean their teeth once daily, and 29% clean teeth twice daily.Again,about 30% brush their teeth at night and 95% brush their teeth in the morning.Moreover,a maximum of 68%use toothpaste and brushes while only 4%use meswak for cleaning their teeth.About 4%of cases with no debris,51% of cases with less than 1/3rd of the tooth with debris,32% of cases with 1/3rd–2/3rd of the tooth with debris,and 13%of cases with more than 2/3rd of the tooth with debris were present.Again, about 30% had no calculus, 52% less than 1/3rd of tooth, 16% in between 1/3rd and 2/3rd of tooth, and 2% more than 2/3rd of calculus was present.About 47% of mild, 22% of moderate, 6% of severe and 25% of absence of inflammation.

Figure 3 Distribution of the respondents by Oral health practice(n=100).Among the respondents,20.69%were advised for scaling,19.66%for filling, 16.90% for root canal treatment, 17.59% for extraction, 17.24% for prosthodontic treatment, 1.03% for orthodontic treatment, 2.07%for pulpotomy, 2.41% for pulpectomy, and 2.41% for minor surgery advised for treatment purposes.

Again, in our study, 72% were decayed, 31% were missing, and 24% were filled cases.Furthermore, dissimilar findings were found in another study whereas about 20 to 34 years old, 35 to 49 years old,and 50 to 64 years old had decayed (0.93, 0.75, 0.55), missing (0.62,2.39, 5.30) and filled teeth (4.61, 7.78, 9.20) approximately.

Another study conducted on the Tongi slum dwellers shows a negative trend, with mean DMFT increasing with the progression of age.The mean DMFT was 1.51 in the 0–10 year age group and 10.61 in the older age group (over 60 years).This difference in mean decayed missing filled tooth according to age was highly significant statistically.Both decayed and missing components revealed an increasing trend with age, which was also statistically significant.On the other hand, filling components decreased as age progressed [13].

In terms of frequency of cleaning teeth, 71% clean teeth once daily and 29% clean teeth twice daily, whereas about 30% brush teeth at night and 95% brush teeth in the morning.This might be the significant cause of the more decayed teeth among the population.The dissimilar finding was again found in another study conducted in the selected school in the old Dhaka city, Bangladesh.About 40.5% of students clean their teeth in the morning and 2.5% in the evening.Again, 57.6% clean two times a day and only 41.1% clean their teeth once daily [11].

Furthermore,a maximum of 68%of respondents use toothpaste and brushes while only 4% use meswak for cleaning their teeth.In addition, a similar finding was found in a study where 93.25% of first-year dental students and 89.6% of first-year medical students used tooth brushes twice daily [12].

In our study, about 51% of the respondents had less than 1/3rdof the teeth with debris,and only 13%of the respondents had more than 2/3rdof the teeth with debris.Again, 30% had no calculus, 52% had less than one-third of a tooth, 16% had between one-third and two-thirds of a tooth, and 2% had more than two-thirds of a tooth.Moreover, 47% had mild, 22% had moderate, 6% had severe and a maximum of 25% had no calculus.

But other research revealed the opposite finding, such as the majority of the participants had abundant and moderate plaque accumulation, which is a clear sign of the poor oral hygiene status of the study population.A higher prevalence of gingivitis was observed in both younger and older age groups because of poor oral hygiene.This supports the findings that slum dwellers living in socio-economically deprived conditions have a high level of dental disease and poor oral health status [14–17].

Furthermore, in our study, about 20.69% advised for scaling,19.66% for filling, 16.90% for root canal treatment, 17.59% for extraction, 17.24% for prosthodontic treatment, 1.03% for orthodontic treatment, 2.07% for pulpotomy, 2.41% for pulpectomy,and 2.41% for minor surgery advised for treatment purposes.

The above findings reflect the similar treatment advice that was revealed in July 2015 study in the Journal of the American Dental Association that found that scaling and root planning are beneficial to patients with chronic periodontitis (gum disease that has advanced past gingivitis).Chronic periodontitis affects 47.2% of adults over 30 in the United States [18].

Conclusion

Overall, about 72% of the respondents, mostly the students, are suffering from decayed teeth,which may be due to a lack of frequency of brushing, indicating 95% that it is once daily.In addition, the most alarming situation among them is about 20.69% required scaling,which may be due to improper and inadequate brushing maintenance.So, to some extent, the above scenario may reflect the negative hallmark for our country’s younger generation in terms of oral health practice.

Now it is very important to give importance to good oral health maintenance, which will further help to build up the general health and well-being of the population.Hence, preventing caries is an essential element in public health efforts.Personal hygiene care(proper brushing with fluoride toothpaste and flossing daily) and dietary modification (minimizing snacking, chewing gum, milk and green vegetables) are recommended.Raising public awareness about dental check-ups may assist in early diagnosis.Therefore, the establishment of a preventive oral health policy by our policymakers for the general population, mostly school-going students, on an emergency basis.