Reasons and Associated Problems for Not Replacing Lost Teeth: A Cross-sectional Survey

Published by Oriental Scientific Publishing Company © 2018 This is an Open Access article licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (https://creativecommons.org/licenses/by-nc-sa/4.0/ ), which permits unrestricted Non Commercial use, distribution and reproduction in any medium, provided the original work is properly cited. Reasons and Associated Problems for Not Replacing Lost Teeth: A Cross-sectional Survey

Oral health plays a vital part in the maintenance of the overall health of a person.Healthy teeth are essential not only for physical but also for psychological well-being 1,2 .The common reasons for missing teeth are dental caries, periodontal disease, trauma & congenital 3,4 .Edentulism, not just outcomes in decreased oral capacities yet, in addition, remains a major public health issue 5 .
For over the years clinicians have hypothesized a requirement for tooth substitution in the upkeep of oral wellbeing.Hirschfeld inferred that inability to supplant a missing tooth could prompt caries as well as periodontal disease and proposed that tooth replacement will avert unwanted changes in tooth position 6 .It also felt that maintenance of intact arch was imperative in the upkeep of oral health 7 .The complications of not replacing teeth are improper speech, the inefficiency of mastication, changes in occlusal stability, the occurrence of temporomandibular joint disorders, lifting and drifting of teeth & alveolar bone loss [7][8][9] .
In many developed western countries, the conflicting data exist, regarding the increase or decrease in the prevalence of partial edentulism and tooth loss 10,11 .But most of the patient undergone replacement for tooth loss with some type of prosthesis 12 .In developing countries like India even though there are oral health programs and awareness campaigns, it seems to be many patients who are in the suburban & rural areas does not undergo replacement of teeth 13 .
The aim of the study is to find out and to understand the reasons and the associated problems for not replacing the lost teeth and to make an attempt in reducing the possible cause and thereby improving the quality of life.

MATERIALS AND METHODS
A cross-sectional study was conducted to find out the reasons for not replacing the lost teeth, in partially edentulous patients visiting as an outpatient (OP) to Faculty of Dental Sciences, Sri Ramachandra Medical College and Research Institute, Chennai.Patients aged above 25 years with as a minimum of one missing teeth (excluding third molars) visiting the Institute other than that for replacement of the missing teeth were included in the study.Completely edentulous, mixed dentition, patients with developmental problems and poor mental health patients were excluded from the study.Institutional ethical clearance was obtained (CSP/17/JAN/54/57) to conduct the study, and the purpose of the study was explained to each participating patient in their own regional language and the consent was obtained for the same.
The predesigned and structured questionnaire containing seven (closed end) questions along with the details of the sociodemographic status were recorded.Out of seven questions, six were on a two-point scale (yes & no), one question had three options (unawareness, economic & busy lifestyle).Clinical examination was also evaluated to record the number and positions of the missing teeth.A single trained investigator explained all the questions in their regional language and recorded the answers which are followed by a clinical examination to record the clinical status of the patient's oral cavity.All the data were collected and analyzed using statistical software (SPSS for Windows, version 21; SPSS Inc., Chicago, IL).

RESULTS
A total number of 300 patients included in this study, out of the 300 patients, 136 patients are male (45%) and 164 patients (55%) are female with the age ranging from 25 to 60 years old.In this study, lost teeth were categorized as anterior or pos terior, so that to have a distinction between aesthetic and functional needs for replacing the teeth.However, first premolars are considered to be important for both esthetics and function, they were included in both the classifications.
From the results, it was found that 22% of the patients have only anterior teeth missing, 42% of the patient has only posterior teeth missing and the remaining 36% of the patient had both anterior and posterior teeth missing (Table 1).When considering the duration of edentulousness 52% of the patient have not replaced the teeth for more than a year and only 13% of the patient are being edentulousness for less than 6 months (Table 2).
42% of the patients find economic reasons as the main burden for not replacing the lost teeth which are followed by 33% of patient finds lack of time as the reason and the remaining 25% of the patients were unaware of replacing the missing teeth (Table 3).In terms of accessibility to the hospital, 63% percent of the patients are residing near to the hospital (Table 4).
Masticatory function: In comparison with the female patient 50%, male patients 62% were found to be not satisfied with their existing oral condition (Table 5).
Aesthetic condition: In comparison with the male patient 40%, female patients 61% were found to be not satisfied with esthetics (Table 6).

DISCUSSION
This present investigation based on the perception that among the individuals visiting the dental college with partial edentulousness, only a few of them get their teeth replacement.A total of 300 patients participated in this study of which 45% were male and 55% were female with a mean age of 25 to 60 years.The key reason behind the nonreplacement of the lost teeth was found to be the financial problem or economic reasons followed by busy lifestyle and lack of awareness.There was a high ratio of lack of awareness in female patients compared to male patients.Abijeeth et al 14 reported that busy lifestyle was the key reason for non-replacement but in this study, it is found that financial problem is the main hurdle in replacing the teeth.
Individuals with a higher level of education and monetary wealth have better access to dental care and furthermore, put a higher significance on oral health 15 .Inadequate education, the awareness about the significance of oral health, the requirement for preventive services and the outcomes of disregard seem to constitute a huge impediment to oral health 16,17 .Patients generally give more importance to general health care than oral health care and also generally, in India, existing health insurance schemes are not covering the oral health as it comes under cosmetic treatment.When compared with the developed countries, only 17 percent of the Indian population are estimated to have access or preferred to avail health insurance schemes either by owing individually or it is provided by their employees 18 .
Replacement of missing teeth is dependent on the patient perception of either function or esthetics in their oral cavity.It is also noted that the esthetics is the major driving force for the patient to replace the missing teeth.The prospect of an upright esthetic result generally inspires the patient to have the prosthesis and esthetics can be more important than function for several individuals 19 .Indeed, even in nations with high propelled dental care frameworks, open spaces or edentulous zones in the molar region are acknowledged by the general population 20 .In this study, males are more concerned with masticatory efficiency as they consider it to be more important than aesthetics and prefer functioning of their teeth, whereas females are concerned with the aesthetics of the dentition rather than function.
As indicated by Leake et al, the individual requirement for prosthetic substitution of posterior teeth is frequently low, as such substitutions, rarely enhance the person's societal position 21 .This study showed that majority of the patients having missing posterior teeth had more than the one-year duration of edentulousness [90%].It was also noted that as the duration of edentulousness increased, the individuals are getting accustomed to their compromised dentition and willingness towards the replacement of their missing teeth gets comparatively decreased.Moreover, as tooth loss for happens over some undefined time frame, it allows the person to change in accordance with the condition with no clear dissensions on their functioning of the teeth 22 .Subsequently, many older individuals may not recognize the requirement for substitution of the missing teeth despite losing substantial numbers of teeth as they have adjusted to their missing teeth over a period of time 23 .
However, there are few limitations of this study like only the patients visiting the dental college were only selected and included in the study and also the duration of the study is less when considering the huge population of the country.However, in near future, studies have to be conducted in a larger population to represent a bigger country like India.

CONCLUSION
Within the limitation of this study, out of the various reasons listed, the economic burden of replacing the missing teeth was found to be the key reason for non-replacement.It can be suggested that to reduce these problems and to create awareness of replacing the missing teeth, the Government of India and the insurance providers can include the dental treatment in their list of treatment covered by the health insurance.Vigorous campaigning in rural and suburban areas about the importance of replacing the missing teeth and the general oral health care may also improve the oral status of the population which in turn results in a healthy oral status.

Table 1 .
Distribution of Missing Teeth

Table 2 .
Duration of Missing Teeth

Table 3 .
Reasons for Non Replacement

Table 4 .
Convenience to Reach the Hospital

Table 5 .
Efficiency of Masticatory Function

Table 6 .
Esthetic Satisfaction about Present Condition