Factors Associated with the Utilization of Prosthetic Dental Restoration at Ras-Al-Khaimah Dental Center, United Arab Emirates
Ras-Al-Khaimah (RAK) is located on the Arabian Gulf. It borders Umm Al Quwain , Sharjah, and fujairah and has long borders with the Sultanate of Oman. The total area of the Emirate of Ras-Al-Khaimah is 2478 Sq.Kms. according to the survey administration of municipality department. In 2007 the total Population of Ras-Al-Khaimah was officially estimated at 214.000, 132.000 Male and 82.000 Female .
During 2006 the number of attendants to the Dental Clinics in Ras-Al-Khaimah was 45.519 patients, 8.712 were citizen of whom 2.088 were new cases & 6.624 were follow up cases. Prosthetic treatments are provided by RAK dental center only (where only UAE nationals entitled to receive treatment free of charges). Cases treated are referred from the all dental clinics in Ras-Al-Khaimah.
It well known that total or partial edentulism is a good indicator of the oral health of population [2, 3]. Edentulism can substantially affect oral and general health as well as the overall quality of life [4, 5]. Teeth play an important role in the maintenance of a positive self-image. Therefore, loss of teeth results in significant disabilities, which can profoundly disrupt social activities. Tooth loss is very traumatic and upsetting and is regarded as a serious life event that requires significant social and psychological readjustment [6, 7].
Whilst specific diseases like dental caries and periodontal disease are the major cause of tooth loss [8, 9, 10], several non-disease factors such as attitude, behavior, dental attendance, and characteristics of the health care system tend to influence in the decision to become edentulous . Significant relationship between socio-demographic variables and edentulism, with age and socio-economic status playing vital roles in edentulism and denture demand . Many studies reported that the incidence of edentulism correlated with educational levels and income status, with those in the lower levels exhibiting higher risks of becoming totally edentulous [13, 14].
Furthermore, inadequate diet contributed to widespread premature and heavy losses of permanent teeth . Tobacco use is a risk factor in tooth loss particularly in people having a high consumption over several years . Recent surveys have shown higher frequency of tooth loss among adults in the industrialized countries than among their counterparts in developing countries, where access to dental care is limited [17, 18]. In some circumstances stress and other psychological factors may greatly impact health status [19, 20], including oral health. In order to improve the quality of life that is compromised because of the loss of teeth, dentists often recommend removable or fixed prostheses for patients with missing teeth.
Epidemiological data on health and its related issues are very important in order to plan for future health care provision. To our knowledge, there is no epidemiological study on edentulousness or prosthetic dental restoration in Ras-Al-Khaimah. The aim of the current study is to determine the prevalence of various types of prosthetic dental restorations among patients who been treated in the prosthetic department of RAK dental center (the only government dental center which provides this service in RAK) and to investigate its association with some of the socio-demographic characteristics and general health status.
Data has been collected from the patient’s files that have been treated in RAK dental center between February 2005 – December 2007 (patients who came for consultation only or did not finish there treatment were not included in this study). Ethical approval for the study was obtained from the ministry of health – RAK medical district. The collected data included the age, gender, employment status and the general health condition of the participants, in addition to types of prosthetic restoration used.
According to the type of the prosthetic restoration used, nine categories were included:- (1) complete denture (fully edentulous), (2) single complete denture, (3) single complete denture with partial ( removable or fixed), (4) single removable partial denture, (5) more than one removable partial denture, (6) Removable partial denture with Fixed partial denture (one or more), (7) single fixed partial denture (bridge or implant), (8) more than one fixed partial denture (bridge or implant), (9) crown or crowns. Regrouping had been made as follow: (1) “complete denture” (fully edentulous), (2) “single complete denture” and/ or single complete denture with partial, (3) “removable partial denture” representing single removable partial denture, or more than one removable partial denture, or removable partial denture with fixed partial denture (one or more), (4) “fixed partial denture”, representing single fixed partial denture (bridge or implant), or more than one fixed partial denture (bridge or implant). (5) for “Crowns”.
Unfortunately patients’ level of education was not mentioned in the patient’s file so we choose employment status as an alternative. General health condition included four categories: Healthy, Diabetics, Hypertension, and other illness. Data were analyzed using SPSS program version 13.0.
A total of 1009 patients were included in this study, 358 (35.5%) male and 651 (64.5%) female. The age rang of the participants was 25-70 years with the mean age of 44.8 (sd=14.0) years.
The utilization of complete dentures, single complete dentures (with or without other prosthetic restoration) and removable partial denture (one or more) were (17.4%), (7.8%), and (39.3%) respectively while, the utilization of the fixed restorations (bridges or implant), crowns were (20.4%), (15.0%) respectively (data not presented).
The association between various type of prosthetic dental restoration used and other variables (age, gender,employment status and medical history) are presented in Table 2. The use of the removable dental prostheses (RPDs) was the highest 397 (39.4%). There was statistically significant association between wearing complete denture in both jaws or single complete denture (with or without other prosthetic restoration), and age. The uses of RPD were significantly higher in patients younger than 65 years. Similarly the uses of fixed restoration were significantly higher in patients younger than 65 years. Crowns were used more often in patients aged from 25-34 years.
There was a significant assosiation between gender and the demand for prosthetic dental restoration, 64.5% of the female used it, while only 35.5% were male (Figer 1). Complete dentures in both jaws were significantly more common among female 103 (10.2%) than among male 73 (7.2%). While, the rate of single complete denture (with or without other prosthetic restoration) almost the same among both male and female patients. Compared with 230 female, only 167 of male were having one or more removable partial denture. Females utilization of fixed restorations were three times more than male, similarly the utilization of crowns were four times higher among female.
With regared to the employment status and the utilization of various types of prosthetic dental restoration, it was quit clear that the unemployed participants were the group of highest demand for all types of prosthetic dental restoration. Considering the health status, healthy patients (69.5%) tended to use prosthetic dental restoration more often than those with medical conditions.
In the past, tooth loss in adults has been mainly attributed to periodontal disease and caries, moreover, apart from oral disease various non-disease indicators such as socio-demographic factors, dental utilization behaviors have shown to be associated with tooth mortality. Therefore, knowledge of factors that influence the uses of prosthetic dental prosthesis will be important for effective planning and provision of oral health services.
While in developed countries the need for removable partial denture or complete dentures declines, in less developed countries the need for removable partial or complete dentures is still increasing [21 , 22].
As expected and consistent with the findings of other studies [23, 24], the results revealed a significant association between the use of various dental prostheses and age. It is believed that with increasing age, oral and dental problems increase. Although with increasing age, there is decline in taste and smell , which can influence the status of oral health and function; age alone is not responsible for the deterioration of oral health. There may be several other factors such as multiple chronic diseases, intake of several medications and their side effects, socio-economic factors and psychological factors such as depression and isolation (because of gradual loss of spouse and friends and feeling of being unwanted by family members), leading to neglect of personal and hygiene and health [26,27].
In a multivariate analysis of oral health survey conducted on the elderly in the UK, it was found that age and educational level had the largest effect on level of edentulousness, persons over 75 years of age were 144 times more likely to have lost all their teeth compared with persons of 16-44 years of age. Similarly persons with no qualification were nine times and people with qualification below degree level were four times more likely than persons with higher qualification to be edentulous .
Our findings showed that unemployed individuals experienced significantly more tooth loss than the employed participants that might be a reflection of either being retired or have no qualification. In a study reported from Germany on older adults, it was found that educational level had a direct impact on level of edendulousness . Low education level was associated with increased level of edentulousness. Thus, the findings of the present study are in conformity with the German study
Where as lots of studies [30, 31] revealed a significant association between uses of dental prosthesis and age, our study showed that uses of removable and fixed partial denture were significantly higher in patients younger than 65 years, in contrast, complete denture utilization was significantly higher among those who aged 65 and above.
In conformity with the findings of other studies [32, 33] the present study showed that females were more likely to wear dentures than males. the demand for prosthetic dental restoration were 64% amonge female while only 35% males. This probably a reflection of the gender-related differences in the use of dental services. Older woman tend use dental services more often than older man  Moreover for older women, oral health can have impact on their feeling of attractiveness  .This could have contributed to a higher level of denture wearers among women than men.
In the present study employment status also emerged as a factor that influenced denture status, the utilization of all dental prosthesis were higher among unemplyed patients, being unemplyed might reflect the level of educational attainment this is consistent with finding of Shah et al. study , where he reported that the prevalence of wearing of dentures increase with the increase in the level of literacy.
This study reveals that the prevalence of wearing RPDs was high among the prosthetic departments` patients in RAK dental center. The highest frequency of fixed and RPDs among unemployed may reveal an association between tooth loss and education attainment or due to low level dental health care awearness. Further research is required to identify factors contributed to tooth loss among those patients. Efforts are needed to increase dental health care awareness among such group of patients by implementing some educational program. This study might be considerded as a base line for further study to be conducted in the future.
The authers would like to thank the staff of RAK dental center for their assistance in this study .
1. The Studies and Statistics Administration Department. Economic Development Statistical Year Book 2007.
2. Marcus PA, Joshi A, Judith AJ, Morgano SM. Complete edentulism and denture use for elders in New England. Journal Prosthetic Dentistry 1996; 79:260-266.
3. Brodeeur JM, Benigeri M, Naccache H, Olivier M, Payette M. Trends in the level of edentulism in Quebec between 1980 and 1993. Journal of the Canadian Dental Association 1996; 62:159-160.
4. Lacopino AM, Wathen WF. Geriatric prosthodontics: an overview, Part I. Pretreatment consideration. Quintessence International 1993; 24:259-266.
5. Lacopino AM. Wathen WF. Geriatric prosthodontics: an overview. Part II. Treatment consideration. Quintessence International 1993; 24:353-361.
6. Omar R, Tashkand E, Abduljabbar T, Abdullah MA, Akeel RF. Sentiments expressed in relation to tooth loss: a qualitative study among edentulous Saudis. International Journal of Prosthodontics 2003; 16:515–20.
7. Fiske J, Davis DM, Frances C, Gelbier S. The emotional effects of tooth loss in edentulous people. Br Dent J 1998; 184:90–93.
8. Kaimenyi JT, Sachdera P, Patel S. Causes of tooth mortality at the Dental Hospital Unit of Kenyatta National Hospital of Nairobi, Kenya. Odonto-Stomatologie Tropicale 1988; 1:17-20
9. Brekhus PJ. Dental disease and its relation to the loss of human teeth. Journal of American Dental Association 1929; 2237-2247.
10. MacGregor IDM: Pattern of tooth loss in a selected population of Nigerians. Archive Oral Biology 1972; 17:1573-1582.
11. Bouma J. On becoming edentulous. An investigation into the dental and behaviour reason for full mouth extraction. Thesis Ryksuniversteit te Grmingh 1984.
12. Esan TA, Olusile AO, Akeredolu PA, Esan AO. Socio-demographic factors and edentulism: the Nigerian experience. BMC Oral Health 2004; 4:3.
13. Eklund SA, Burt BA: Risk factor for total tooth loss in the United States: Longitudinal analysis of national data. Journal of Public Health Dentistry 1994; 51(1):5-14.
14. Caplan DJ, Weintraub JA. The oral health burden in the United States: a summary of recent epidemiologic studies. Journal of Dental Education 1993; 57(12):853-862.
15. Hunter JM, Arbona ST. The tooth as a marker of developing world quality of life: a field study in Guatemala. Social Science Medicine 1995; 41(9):1217-1240.
16. Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dentistry Oral Epidemiology 2005; 33(2):81-92.
17. Manji F, Baelum V, Fejerskov O. Tooth mortality in an adult rural population in Kenya. Journal Dental Research 1988; 67(2):496-500.
18. Henriksen BM, Axell T, Laake K. Geographic differences in tooth loss and denture wearing among the elderly in Norway. Community Dentistry Oral Epidemiology 2003; 31:403-11.
19. Angelilo IF, Sagliocco G, Hendricks SJ, Villari P. Tooth loss and dental caries in institutionalized elderly in Italy. Community Dentistry Oral Epidemiology 1990; 18:216-218.
20. Pallegedara C and Ekanayake L. Tooth loss, the wearing of dentures and associated factors in Sri Lankan older individuals. Gerodontology 2005; 22: 193-199.
21. Moskona D, Kaplan I. Oral health and treatment needs in a non-institutionalized elderly population: experience of a dental school associated geriatric clinic. Gerodontology 1995; 12:95-98.
22. Dolan TA, Gilbert GH, Duncan RP, Foerster U. Twenty-four month incidence of root caries among a diverse group of adults. Community Dentistry Oral Epidemiology. 2001; 29:329-340.
23. Slade G, Spencer J, Gorkic E, Andrews G. Oral health status and treatment needs of non-institutionalized persons aged 60+ in Adelaide, South Australia. Australian Dental Journal. 1993; 38:373-380.
24. Shah N, Parkash H, Sunderam R. Edentulousness denture wear and denture needs of Indian elderly, a community based study. Journal Oral Rehabilitation 2004; 31:467-476.
25. Shah N. Geriatric oral health issues in India. International Dental Journal 2001; 51:212-218.
26. Ship JA. The influence of aging on oral health and consequences for taste and smell. Physiology behavior 1999; 66:209-215.
27. Ganguli M, Dude S, Johnston JM, Pandav R, Chandra V, Dodge HH. Depressive symptoms, cognitive impairment and function impairment in a rural elderly population in India: a Hindi version of the geriatric depression scale. International Journal of Geriatric Psychiatry. 1999; 14:807-820.
28. Treasure E, Kelly M, Nuttal N, Nunn J, Bradnock G, White D. Factors associated with oral health: a multivariate analysis of results from the 1998 Adult Dental Health survey. British Dental Journal 2001; 190:60-67.
29. Nitschke I. Geriatric oral health issues in Germany. International dental Journal 2001; 51:207-211.
30. Al-Shammery A, El-Backly M, Gutle EE. Permanent tooth loss among adults and children in Saudi Arabia .Community Dental Health 1998; 15: 277-280.
31. Klein BE, Klein R, Knudston MD. Life style correlates of tooth loss in an adult Midwestern population. Journal of Public Health Dentistry 2004; 64:145-150.
32. McGrath C, Bedi R. Sever tooth loss among UK adult –who goes for oral rehabilitation. Journal Oral Rehabilitation 2002; 29:240-244.
33. Ettinger RL, Worren JJ, Levy SM, et al. Oral health: Perceptions of need in a rural Iowa county. Special Care in Dentistry 2004; 24:13-21.
34. Trulsson U, Engstrand P, Berggren U et al. Edentulousness and oral rehabilitation: experiences from patients’ perspective. European journal Oral Sciences 2002; 110: 417-424.
by Dr. Raghad Hashim and Dr. Israa Hadi