PREVALENCE OF MISSING FIRST MOLAR ON SOUTH INDIAN POPULATION- A RETROSPECTIVE STUDY

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1 REVIEW ARTICLE PREVALENCE OF MISSING FIRST MOLAR ON SOUTH INDIAN POPULATION- A RETROSPECTIVE STUDY Mithra.N.Hegde* MDS; Ragavendran* MDS *Department of Conservative Dentistry& Endodontics A.B.Shetty Memorial Institute of Dental sciences, Mangalore, Karnatatka, India. Address for correspondence: Dr.Mithra.N.Hegde, Senior Professor & Head of Department of Conservative Dentistry& Endodontics,A.B.Shetty Memorial Institute of Dental sciences, Deralakatte, Mangalore Karnatatka, India. address: drhegdedentist@gmail.com Abstract : The aim was to determine the prevalence of missing first molar in patients of dakshina kannada population in the last 5 years.a random sample of 2000 patients per year for 5 years from a total population of 16,56,165 of dakshina kannada district, india were included for the study. Consent form was duly obtained and patient was examined clinically for loss of first molar and history was recorded for the reason of loss of first molar. The relation to specificity of tooth, age, sex, location, diet, aetiology, brushing method and frequency to find any signification association. The prevalence is about 36.06% over these 5 years of study with mandibular right first molar has the higher prevalence of 30.64% than maxilla. It is more commonly seen from 4 th decade with rural population has higher predominance of 36.5% than urban population of 35.76%. Dental caries is the main aetiology factor behind the loss of first molar which constitutes of 75.62% than periodontitis of 22.76%. Based on occupation house wife (47.31%), labourer (40.03%) shows higher prevalence than others.the most common cause for the loss of first molars was found to be caries followed by periodontal disease. Thus it still reflects the need for dental health education in community and a positive attitude towards dental health. Keywords: first molar,prevalence, tooth loss. Introduction coupled with expensive replacement of the missing tooth. The first molar is the first tooth to develop among permanent dentition. It initiates its development at Materials and methods: birth and erupts in the oral cavity at the age of 6-7 This Study was conducted to collect information on years. During this period, it is the last tooth in the the prevalence of loss of first molar in South India oral cavity and the accessibility and dexterity for by examining the south canara population for 5 maintaining the oral hygiene is difficult. Moreover years. The south canara Dakshina Kannada district is the deep pit and fissure nature of the first molar than in Karnataka state, India of 4866 km2 area, other tooth makes it more prone for food lodgement, population density around 390 per square km with a which in turn leads to dental caries. The negligence total population of 16, 56,165 in this district. The towards the treatment of dental caries in initial stage rural and urban population is 11, 22,723 &5, 33,442 and lack of awareness in retaining it after respectively with a male female ratio around symptomatic pulp involvement leads to loss of the 1000:1020.Every year a total of 2000 patients were teeth(1,3). Since the first molar is the corner stone of examined from dental hospital of NITTE university our mouth, its loss result in reduced masticatory and its rural satellite centres of Mangalore after efficiency, migration of the adjacent teeth, supra obtaining the written consent, in which 1200 were eruption of opposing tooth, occlusal disharmony examined in NITTE university dental college and Downloaded from

2 rest 800 were examined in rural satellite centres of NITTE university to avoid the rural population dominance. Each patient was examined for missing first molars under dental chair in a good illumination of light using sterilized mouth mirror, explorer, and tweezer. The Patients who had missing first molar teeth were questioned with a standard questionnaire to find its relation associated with age, gender, location, occupation, diet, reason and brushing method.the patients with completely edentulous, multiple missing of teeth due to syndromes, physically and mentally diseased individuals are excluded from the study. It was performed by well trained dentists and dental assistants recorded the data on prepared survey form. The results were subjected to statistical analysis by chi-square test to determine the p value of each criterion. Results: The prevalence of the first molar over these 5 years is about 36.06%. It increases from 24.9% from 2007 to % in Mandibular first molar loss was more prevalent than maxillary tooth loss particularly; mandibular right molar (30.64%) shows the maximum and maxillary right showed the least (16.83%) which is highly statistically significant. (Table 1, 2) loss of first molar is seen significantly from the 36-45(3rd, 4th decade) [47.39%] years and increases as the age advances. Based on gender males and females didn t found to show significant results. (table3, 4) Rural population (36.5%) has higher prevalence to loss of first molar when compared to urban population (35.76%). It was found statistically significant even though the difference is not very high (table 5). Dental Caries (75.62%) was the most prevalent etiological factor for the loss of first molar than periodontitis (22.76%). (Table 6). Based on occupation house wife (47.31%), labourer (40.03%) shows higher prevalence than others (table 7).Based on diet and brushing in the role of missing first molar didn t prove any significant association in it (table 8-11). Downloaded from

3 Discussion: The loss of first molar over these 5 years is about 3606 with a prevalence of around 36.06%. Among these 3606 first molar patients 3413 had only single first molar missing and rest 193 with multiple molar missing. This could be because of patient s awareness created in during loss of first tooth and Downloaded from

4 missing first molar. Thus gender didn t influence any difference in loss of first molar though males showed a slight prevalence than females.but Locker D, J. Ford and J. L. Leake in their study on incidence of and risk factors for tooth loss found that males had more percentage of losing one or more teeth than females(5). But, contradictarly Ferlin et al in their study results indicated that teeth loss of first permanent molar was significantly higher in females(6).of total samples, 4000 and 6000 were examined in rural & urban population. Rural population showed significantly higher prevalence in the loss of first molar of 1460 (36.5%) than urban (35.76%). The prevalence in the rural is high due to the fact of decreased awareness and maintenance of oral hygiene when compared to urban population though the difference is not much in these five years. Danielson et al in his Nigerian rural study also found that main reason for the loss of tooth is due to late presentations and ignorance on oral health issues among the rural population(7). fear of losing more teeth. The mandibular first molars are more prone to loss when compared to the maxilla, it is due to the position and presence of parotid duct could be the reason on the opposite to maxillary molar one of the defence mechanism for the decreased loss of first molar. We also know that saliva is the first line of defence in oral cavity. Artun and Thalib in 2011 also stated the prevalence of loss of first molar and mesial migration was more common in mandible 70% (1). In this study mandibular left first molar (30.89%) missing was highest followed by mandibular right (29.5%0, maxillary left (24.40%) & maxillary right first molar (16.83%). The prevalence of left molar missing is more than right side is due to the decreased dexrity in cleaning the dominant side while brushing. Upadhaya C et al (2) stated that mandibular first molar was the most frequently extracted tooth due to dental caries followed by maxillary first molar.from years of age the missing first molar is low about 15-28%.but, the prevalence is steadily rising from the mid of 3rd to 4th decade (47.39%) and as the age advances the probability to lose the molar is increased and reaches 68% by 6-7 th decade. This increase is due to the increased progression of caries and coupled with periodontitis as the age advances, which in turn decreases the prognosis of the tooth. Vignarajah S(4) in his study on various reasons for permanent tooth found that greater prevalence of loss of tooth was seen in age 40 years and above. Based on the occupation, 47.31% of house wife, 40.03% in labourer and 39.91% bussiness men/women showed higher prevalence in the loss of first molar. It s because of low socioeconomic status, decreased awareness in dental health & maintenance. Considering the low cost and lesser visit, the labourers prefer removal of natural teeth which saves their daily wages in work and time rather than multiple visits to save the tooth. Both students and professionals were well known about the importance of retaining a teeth the loss of first molar is seen less among them. Ferro et al in 2012 found the socioeconomic factor is still a predicting factor for dental caries experience, which results in loss of tooth in future(1). Witt MC also found the DMFT was more in poor socioeconomic background(8). Both vegetarian and mixed diet showed similar relationship in loss of first molar of 35 %( approx). So the difference in the diet of the population didn t influence any significant association with loss of first molar. The most common cause for the loss of first molar is dental caries which constitutes about 75.62% over these five years. About 2727 patients lost due to caries and 821 patients due to periodontitis (22.76%).Dixit et al(9) mentioned in their study that dental caries was the reason for the extraction of permanent first molar and Upadhaya et al(2) in their study found that highest portion of extraction due to caries occurred between years of age while that of periodontal disease was Males and females showed a more or less similar prevalence of 36.21% and 35.88% respectively. Out of 5421 males & 4579 females 1963 & 1643 had between years of age.they also state that Downloaded from

5 young group of people lost their teeth the maximum canadians journal of dental research, 1996; 75: due to dental caries. Grace Ong, Jinn-Fei Yeo and Sameer Bhole(10) in their study on the reasons for 6. Ferlin Lh, Daruge Ad, Daruge Rj, Rancan Sv extraction of permanent teeth found caries as a Prevalence of first permanent molar loss in 6 to 12 major cause for loss of molar, followed by year of both sexes in ribeirao preto Rev odontol univ periodontal disease. Hence in this study conducted sao paulo 1989; 3: in Dakshina Kannada district in which dental caries is most common disease. Both urban and rural population has the highest incidence of loss of first molar due to dental caries. Oral hygiene maintenance with paste and brush showed lesser prevalence of loss of first molar over other technique of oral hygiene but was statistically not significant. The brushing frequency also didn t show any significant difference.vertical method of tooth brushing showed better oral hygiene than other methods. Conclusion: The prevalence for the loss of first molar in South canara population is 36.06%. This prevalence ratio is increasing over these 5 years from 2007 to The loss of first molar is seen higher in house wife and labourers and dental caries is the main aetiology for this which constitutes about 75.62%. Hence the need for dental health education & prevention among the Indian population is to be overemphasized to avoid this further loss of tooth in the future. References: 1. Artun J, Thalib L Mesial amigration and loss of first molars among young adolescents in kumait. Journal Of Community Dental Health 2011; 28: Upadhaya C, Humagain M The pattern of tooth loss due to dental caries and periodontal disease among patients attending dental department(opd),dhulikhel hospital,kathmandu university teaching hospital(kuth),nepal. Kathmandu University Medical Journal 2009 ; 7 : Caglaroglu M, Kikic N, Erdem A Effects of early unilateral first molar extraction on skeletal asymemtry. Am j orthod dentofacial orthop 2008 ; 134: Vignarajah S Various reasons for permanant tooth extractions in a carribean population Antigua International dental journal 1993; 43: Locker D, Ford J, Leake Jl Incidence and risk factors for tooth loss in a population of older 7. Danielson Oe, Chinedu Ac, Oluyemisi Bo, Nbubuisi Oo Frequency, causes and pattern of adult tooth extraction in a nigerian rural health facility Odontostomatol trop ; 34: Ferro R, Besostri A, Olivieri A, Stellini E, Denotti G, Campus G.caries experience in 14- year olds from north east italy. Is socioeconomic ststus (ses) is still a risk factor? Eur j paediatr dent 2012 mar; 13: Witt Mc Pattern of tooth loss in a 12-year old brazilian population to socioeconomic backround acta odontol scand 1992 ; 50: Ony G, Yeo Jinn Fei, Bhole S A survey of reasons for extraction of permanent teeth in Singapore Journal of community dentistry and oral epidemiology. 1996;24: Downloaded from