Prevalence Of Tooth Loss In Saudi Arabian School

Children: An Epidemiological Study Of

Saudi Male Children

Studies concerning prevalence and incidence of tooth loss in young adults provide essential epidemiological data. The information obtained may be used to assess the state of dental health and form a baseline for planning future dental care programs in the society. Salzmann1 stated that "the epidemiologic determination of a disease is the first step in public health endeavours". According to Todd and Walker2 dental health can be estimated to an extent, by the study of total tooth loss. Recently a multinational survey including America, Australia, Asia, and Europe was carried out to determine the prevalence of tooth loss among 15-year-old schoolchildren. The findings indicated an average of 0.4 missing teeth ranging from 0.1-1.2 per person.3 Barnard et al4 and Stamm5 found the number of lost teeth in a similar age group varied between 0.1 to 2.2 missing teeth. Legler et al6 reported a total of 0.51 lost teeth per person among secondary school students in Iraq.
It is generally believed that tooth loss in young adults is mainly caused by dental caries; whereas periodontitis, as a cause of tooth loss, become more prominent after the age of 35 to 40 years.7 Cohen et al8 and Johansen9 noted that when dental caries was the predominating reason for extraction, the mandibular first molars were the most fre­ quently affected teeth. It has been found that the prevalence of dental caries in Saudi school- children in Riyadh was about 77 percent.10
Although extraction is the main cause of tooth loss, hypodontia and trauma are other reasons for permanent tooth loss. The frequency of congeni-tally missing teeth among different populations varied from 2.3 to 8 percent,11 the most frequently missing tooth was the mandibular second premo­ lar.12,13 Trauma to the frontal teeth is relatively common in young children, the permanent central incisors are the most frequently affected teeth,14
The aim of this investigation was to provide epidemiological data concerning permanent tooth loss in 14-year-old Saudi male schoolchildren.

This investigation comprised five hundred Saudi male schoolchildren, representing the age range of 13.5 to 14.5 years (mean age 14 years). The samples were obtained from governmental secondary schools in different areas of Riyadh City. The schools were randomly selected according to a recent geographical map, showing the size and location of these areas. No socio-economic class­ ification of the sample was attempted, and there were no racial differences since only children of Saudi Arabian origin were involved.
All participants were examined by the author to avoid inter-examiner variability. The clinical examination was carried out in the schools, in which a portable dental chair, standard disposable mouth mirrors, and explorers were used. All mis­ sing teeth, irrespective of whether they were mis­ sing due to agenesis, extraction or trauma, were recorded. Teeth replaced by bridges were also marked as missing.
At the time this investigation was carried out, there was no possible source of obtaining data about the causes of lost teeth using a random sam­ ple. The children were, therefore, questioned dur­ ing the clinical examination about the cause of their tooth loss. Diagnostic panoramic radiographs were taken for those children appearing to lack a permanent tooth mesial to the first permanent molars. These children were transferred to the King Saud University College of Dentistry and Central Hospital in Riyadh for radiograpic examination. They also received a clinical report explaining their dental problems, and were then referred to the appropriate dental facility. All ageneses, with the exclusion of the third molars, were determined from the radiographs.

The total prevalence of tooth loss involving tooth extraction, hypodontia, and trauma in the present sample was found to be 13.6 percent. Extraction appeared to be the most dominating reason for tooth loss (8.6%) in Saudi schoolchildren, followed by hypodontia (4%) and trauma (1 %) [Fig. 1 ]. The distribution of the missing teeth is outlined in Table 1; the first molars were the most affected teeth. The mean number of tooth loss per child was found to be 0.17. The frequency of missing mandibular first molar was 48.8 percent compared with the other affected teeth, which was roughly three times as common as the maxillary first molar (16.2%) [Fig. 2]
Agenesis of one or more permanent teeth was observed in 4% of the children. The most fre-quently affected teeth were the lower second pre­ molars and the upper laterals.
Trauma to the frontal teeth had caused tooth loss in 1 % of the present sample, the maxillary central incisors were the only affected teeth.
Among those who had lost teeth, the average number was 1.26 tooth loss per person. The major­ ity of those children showed one missing tooth in either jaw. Only 15 children in this sample had two or more missing teeth, either in the maxillary or the mandibular arch [Table 2].

Although several epidemiological studies have been carried out to determine the prevalence of tooth loss among different populations, compari­ son of their findings is rather difficult due to the vari­ ous sampling techniques and the criteria used.
This investigation was concentrated on the occurrence of tooth loss (excluding third molar) in Saudi young adults. Teeth which might be indi­ cated for extraction were not involved in the pre­ sent finding. However, the average number of lost teeth per person (0.17) among the present sample was found to be low as compared with the findings of Legler et al6 in Iraqi students (mean of 0.51 lost teeth). When the present figure (0.17) was com­ pared with the results of the multinational survey concerning the prevalence of tooth loss in 15-year-old children {mean of 0.4 lost teeth per person},3 the prevalence of tooth loss among Saudi children was considered to be minimal. Salem et al15 reported slightly lower frequency of tooth loss in deciduous dentition (0.15) among 296 pre-school-children (3-5 years old). However, the present study was carried out on schoolchildren with per­ manent dentition.
Among those who had lost teeth, the average number was less than what was found in the Brazi­ lian population of 13 to 16-year-olds (mean of 1.8 lost teeth).16 The mandibular first molar was the most frequently affected tooth, extraction was the dominating reason for their loss. This is in agree­ ment with other reports.8,9,16 The teeth that were most frequently missing due to agenesis in this group (lower second premolars and upper laterals) coincided with previous studies.12,13,17 The prevalence of tooth loss due to trauma in this group was found to be 1%. This result is in good agreement with Garcia-Godoy's findings in male schoolchildren in Dominican (1%). However, only the central incisors were affected in the present investigation.

The present investigation affords a survey on the prevalence of total tooth loss among a randomly selected sample from Riyadh City. The finding revealed that the prevalence of tooth loss among Saudi young adults was low as compared to several studies. However, more community dentistry and plans of establishing dental clinics as part of the pri­ mary and secondary school's structure, are man­ datory to maintain a low frequency of tooth loss in the society.

The author would like to thank the College of Dentistry at King Saud University and the Dental Center in Central Hospital, Riyadh, Saudi Arabia, for offering their facilities.