Pattern of Endodontic Treatment in lie-lfe, South Western Nigeria

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1 ".'1"" ~ Pattern of Endodontic Treatment in lie-lfe, South Western Nigeria...~. *A. O. OGINNI, *0. A. OLUSILE and **F. O. OGINNI *Department of Restorative Dentistry, * *Department of Ora/and Maxillofacial Surgery, Obafemi Awolowo University TeachingHospitals Complex, lie-lfe, Osun State, Nigeria. Correspondence t6: Dr. A. O..Oginni Previous endodontic studies in Nigeria were conducted in large metropolitan cities (Lagos and Benin). These revealed that more anterior teeth were treated than posterior teeth. A survey of all teeth treated endodontically (Root cana/therapy) in /le-/fe (a semi urban-population) over a period of three years was conducted. A total of234 teeth were treated in 211 patienls.more posterior teeth 145 (62%) were treated than anteriors 89 (38%). The maxillary central incisors were the most frequently treated 69 (29.5%). More males 114 (54%) Were treated thanfemales 97 (46%). The age group years constituted 60% of the patients treated and caries was the commonest reason for pulp disease. The anatomical considerations for endodontic treatment in posterior teeth are discussed. KEY WORDS: Pattern,' endodontic treatment; teeth. Most of the endodontic treatments in Nigeria are done in the University Teaching Hospitals of the four dental schools in Nigeria namely Obafemi Awolowo University Teaching Hospitals Complex, lie-ife (OAUTHC), Lagos University Teaching Hospital (LUT,H), University of Benin Teaching Hospital (UBTH) and University College Hospital, Ibadan (UCH). Some are carried out in private hospitals which are located in large major cities. lie-ife is a semi urban location in South Western region of Nigeria. Situated within it is the OAUTHC. The OAUTHC is a tertiary hospital with a Restorative Dentistry Department that handles prosthetic and conservative treatment needs of the patient presenting at the hospital. Factors influencing endodontic practice in Nigeria may include the type of dental clinic in the locality, availability offacilities, socioeconomic class of patients and dentist's professional training). Majority of the patients seen at the restorative dentistry department of OAUTHC comprises students and staff of the Obafemi Awolowo University. Some patients come from the surrounding cities and state capitals in south western Nigeria where there are no facilities for endodontic treatment. Other patients are petty traders and civil servants within Osun State. Previous Nigerian studies), 2focused mostly on endodontic technique although the reason for pulp disease and the clinical condition of teeth for endodontic treatment were highlighted. They revealed that more anterior teeth Were treated than posteriors and that the commonest reasons for pulp disease in anterior teeth was direct mechanical trauma. There has been published base line data on the sex and age distrib1jtion and the frequency of occurrence of treatment by individual tooth. It is the aim of this study to.. The Nigeritm Postgrnduutr Medical Journal Vol. 6, No.2, June survey the pattern of endodontic treatment in the Dei-1rtment of Restorative Dentistry, OAUTHC (a semi-urban location). Secondly, the age and sex distribution of patients for endodontic treatment and the frequency of occurrence of treatment by individual tooth will be detel'- mined. Patients and Method The survey included all patients accepted for endodontic treatment (}yera period of 3 years (January 1990to December 1~92) it) the Department of Restorative Dentistry, OAu1HC, lie..jfe. The need for endodontic treatment was confli111edby clinical assessment, vitality test and periapical radiograph. Information extracted from patient's case not~ are,the age of patient, sex, individual tooth treated, reason for pulp disease, and clipical condition of the teeth for endodontic treatment. The incisors and canines are referred to as anterior teeth while premolars and molars are posterior teeth. Teeth that presented for re-treatment following failure of previous endodontic treatment were excluded from the study. Results (' During the study period, a total of 234 teeth were treated endodontically in 211 patients. 145 (62%) were posterior teeth while 89 (38%) were anteribrs. More ~ales 114 (54%) were treated than females 97 (46%). Table I shows the distribution of treated teeth between the sexes. Fig. I shows the age distribution of the patients. Majority of the patients 124 (58.8%) fall between years age group. This is followed by age group 10-19years SO(23.7%). The least number 1 (0.47%) was recorded in the years age group.

2 t /~...,. Endodontic Treatment In De-Ire. South Western Nigeria: A.O. Oginnl, et ai. Table I: Fig. I and 2 shows distribution by individual tooth treated. The most frequently treated tooth was maxillary central incisor 69 (29.5%) followed by the mandibular first molar 44 (18.8%), maxillary first premolars 36 (15.4%) and maxillary second premolars 30 (12.8%) in descending order of frequency. Almost twice as much teeth were treated in the maxilla than in the mandible. 60% Sex distribution of treated patients Sex No. of Patients No. of Teeth (%) (%) Male 114 (54.0) 132 (56.4) Female 97 (46.0) 102 (43.6) Total 211 (100.0) 234 (100.0) Table II: EndodonticaLLy The commonest for pulp disease of the treated teeth was carious involvement of the pulp accounting for 58% of all treated teeth. All tile antelior teeth treated were as a result of trauma except Reasons for pulp disease of treated teeth --. Aetiology No. of anterior No. of posteror teeth (%) teeth (%) Trauma 85 (95.50) 10(6.90) Caries I (1.12) 135 (93.10) Elective a (0.00) 0 (0.00) Iatrogenic 3 (3.37) 0 (0.00) Total 89 (100) 145(l00) a single case of carious involve- 40% 20% 0% Figure 1: 10j Age in years Age distribution of endodontically treated patients Table lll: Clinical condition of teeth that presented for treatment No. with acute No. tender to No. with swelling No. with Teeth pulpitis (%) percussion (%) (%) discharging sinus (%) Incisors 27 (11.5) 40(17.1) 9 (3.8) 12 (5.1) Canines 0 (0.0) I (0.4) 0 (0.0) 0 (0.0) Premolars 20 (8.6) ) 36 (15.4) 25 (10.7) 0 (0.0) Molars 50(21.4) 14 (6.0) 0 (0.0) 0 (0.0) Total 97 (41.5) 91 (38.9) 34 (14.5) 12(5.1) The Nigerian Postgraduate Medical Journal Vol. 6, No.2, June

3 '" f :; t Endodontic TI'cntlllcnt in Dc-Irc, South Westcrn NI&erla: A.a. Ogilllli. ct RI. 30% 25% 20% 15%. 10% 5';" 0% _ Teeth Figure 2: Distribution by individual tooth in the maxillary arch 18% 18% 14% 12% 10% 8'to 6'~ 4% 2';'._~-- - Figure 3: 0% Teeth Distribution!J.yindividual tooth in the mandibular a.'ch ment of the pulp and three cases of iattogenic pulp exposure. In 10 (6.9%) of theijosterior teeth treated, the cause of pulp disease was trauma resulting from biting on pebbles contained in food stuffs. Clinical condition of teeth for endodontic treatment Acute pulpitis was the clinical presentation in 97 (41.5%) of cases. 91 (3~.9%) had acute apical periodontitis presenting with tenderness to percussion and slight extrusion, swelling ranging from slight swelling on the labiallbuccal mucosa in relationship to the apex of the involved tooth to acute dentoalveolar abscess accounled for 34 (14.6%) of the treated teeth. Only 12 (5.1%) cases had discharging sinuses. Discussion t:. - The Nigerian Postgraduate Medical Journal Vol, 6, No.2, June The first striking finding is the low number of tceth that were treated when compared with earlier studies in large metropolitan cities. This, however, should nol be surprising since Ile-Ife is a semi-urban location whl':rethe, level of dental awareness is not as high as in urban communities. Another deterrent factor is the fact that a palient

Endodontle Treatment in De-Ife. South Western Nigeria: A.O. Oginni, et ai.. ''t, ~ I ~., ~ may have to make multiple visits (at least two visits) to complete the treatment.

4 Endodontle Treatment in De-Ife. South Western Nigeria: A.O. Oginni, et ai.. ''t, ~ I ~., ~ may have to make multiple visits (at least two visits) to complete the treatment. Some pati~nts also absconded after the initial treatment to relieve pain. Others preferred extraction which they believe will put an end to the pain at once. This is because most of the patients presented late when there was severe pain or swelling. Also because the cost of endodontic treatment is about twice that of extraction, patients viewed extraction as a cheaper option. More males 114 (54%) were treated than females 97 (46%). This is in agreement with the findings of Adenubi and Rule3 who obtained males 57.8% and females 42.2% in patients between the ages of 9-10 years. The greatest percentage of patients that received endodontic treatment during the study period was in the years age group accounting for 124 patients (58.8%) followed by the years age group in which there were 50 patients (23.7%). This is at variance with the study of Harty, Parkins and Wengraft4 in which the greatest percentage was in the years are group which comprised 724 cases out of 1,139 cases in the study (63.8%) followed by the years group which totalled 300 cases (26.4%). The most frequently treated toot!!)n this study was the maxillary central incisor 69 (~%) followed by the mandibular first molar. This result is also at variance with the study of Sommer and Ostrander5 who found the mandibular first molar to be the most frequently treated tooth and the maxillary central incisor next to it. Ingle and Beveridge6 in their study found the maxillary incisor to account for 45.88% of the 1,229 cases, with the mandibular first molar being the third most frequently treated tooth constituting 10.33% of all cases. Another important finding is that more posterior teeth were treated than anterior teeth, this shows a change in trend from previous studiesi,2. The low number of anterior teeth treated endodontically in this study can be explained by the fact that the prevalence oftraumatised anterior teeth in the rural population is low~r 6.5%7 than that in the metropolitan population 14.5%8. Improved technique such as stepback technique with Weine's modification (Weine 1975)9 and availability of instruments such as flexible Headstroem files makes the canal preparation of posterior teeth with curved roots possible thus enhancing the success of endodontic treatment in posterior teeth. Recent reports show an increasing prevalence of caries in the developing countrieslo. 11. This is in agreement with the finding of this study in that 93.1 % of all the treated teeth were as a result of carious involvement of the pulp. Also, the DMFT has been reported to increase from 1.58 in to 2.15 in It is also of interest to note that 10 (6.9%) of all the posterior teeth treated resulted from occlusal trauma arising from pebbles inside food stuff. This differs from the trauma responsible for fracture of anterior teeth which often resulted from falls. Occlusal trauma from pebbles resulted in vertical split often affecting premolars and commoner in maxillary (6 cases) tllan mandibular premolars (4 cases). Management, will depend on the fracture level. If the fracture line extends minimally below the gingival margin, a combination of ~ndodontic treatment and crown lengthening is done with a cast restoration to restore the tooth. If the fracture is extensive, extending far be)ow the gingival level,th~toothmay be extracted. ' Posterior teeth not only have a more complex root anatom) than anterior teeth, they also have varying pulp canal configuration. Hence, a good knowledge of the estimated length, root anatomy and pulp canal configuration is essential before contemplating endodontic treatment. A study on tooth length in Nigerians by Okpo and Akpatal3 revealed that the mean lengths obtained closely approximated with those in Caucasians. However, there has been no published data on the pulp canal conf~gurations in Africans. Therefore, we rely on the Caucasian figures. Failure to find and fill a pulp canal has been demonstrated to be a causative factor in the failure of endodontic treatment especially in teeth with multiple roots and root canals (premolars and molars). It is of uttermost importance that all pulp canals be located and treated. The first consideration that the dentist must have, in embarking on endodontic therapy, involved the anatomy of the tooth itself. Prior to beginning the access cavity preparation, he should study the radiographs from several angulahons, to have a vivid idea of the number of roots and pulp canal configuration. If on direct periapical exposure he notes that a root canal shows a sudden narrowing or disappearing, it often means that the canal at this point divides into two parts which either remain separate or merge before reaching the apexl5. Having information from the radiographs and a good knowledge of various pulp canal configurations aids the dentist with vital guidelines which facilitate the treatment. Although previous Nigerian studies revealed that more anterior teeth were treated than posterior, the result of this survey shows a change in trend with more posterior teeth being treated. This may be due to increasing dental awareness and patient's desire to maintain a complete, healthy and functional dentition as opposed to extraction. Aclrno\\' ledgement We acknowledge the effort of all dental practitioners who worked in the Department of Restorative Dentistry, Obafemi Awolowo University Teaching Hospitals Complex, lie-ife during the period of this study. References 1. Al;pata E. S. Endodontic treatment in Nigeria. In/. EI/dad. J. 1984; 17: Akpata E. S., Sofolahan O. 0., Ufomata D. Pattern of endodontic practice in Nigeria. Nig. Denl. J. 1983; 4: Adenubi J. 0., Rule D. C. Success rate for root filling in young patients: A retrospective analysis of treated cases. Br. Den/. J. 1976; 141: The Nigerian Postgraduate Medical Journal Vol. 6, No.2, June

Endodontic Treatment In De-Ire, South Western Nigeria: A.O. I!Innl, et ill 4. Harty F.l., Parkins B.l., Wengraf A. M. Success rate in root canal therapy: A retrospective study of cor.ventional -cases.

5 Endodontic Treatment In De-Ire, South Western Nigeria: A.O. I!Innl, et ill 4. Harty F.l., Parkins B.l., Wengraf A. M. Success rate in root canal therapy: A retrospective study of cor.ventional -cases.br. Denl. J. 1970; 128: Sommer R. F., Ostrander F. D., Crowley M. C. Clinical El!dodontics, 2nd ed. W. B. Sauders Co., Philadelphia, 1956; Ingle 1.1., Beveridge E. E. Endodontics, 2nd ed., Lea and Febiger, Philadelphia, 1976; Akpata E. S. Traumatised anterior teeth in Lagos school children. Niger. Med J. 1969; 6: Otuyemi'O. D., Sofowora C. A. Traumatic anterior dental injuries in selected rural primary school children in IIe- Ife, Nigeria. Nig. DellI. J. 1991; 10: Weine F. S., Kelly R. F., Lio P. S. The effect of preparation with endodontic hand piece on original canal shape. J. Endod. 1975; 2: Akpabio S. P. Achieving oral health by the year Community Dental Health Monograph series. London: '5. 10int Department of Community Dental Health and Dental Practice. University College, London and the London Hospital Medical College, Olojuba 0.0., Lennon M. A. Dental caries experience in 12year old school children in Ondo State Nigeria in and CommunilyDenl. Heallh 1987; 4: Akpata E. S., Jackson D. Caries vulnerability ortirst and second pe:rmanent molars in urban Nigeriall' Arch. of Oral Bioi. 1978; 23: Okpo H. E. A., Akpata E. S. Tooth lengths in i'jigcria Endod J. 1986; 19: Stewart G. G. Evaluation of endodontic (l'sills. Dltnl. CUll.NorlhAm. 1967; 11: Vertucci F. J., Seelig A., Gillis R. Root canalulorphology of the human maxillary second premolars. (Iral SlIrg. 1974; 38: i< The NIgerian Postgl'lIduate M~dical JOllrnnl Vol. 6. No.2. June

Index. Note: Page numbers of article titles are in boldface type.

Index. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Adult performance horse dental care in, 505 519 bit seat reduction in, 514 515 canine teeth disorders, 515 diagnostic nerve blocks in,