Problems Presented By Children Attending Emergency

Rooms Of The Dental Clinics In Riyadh

Lanre L. Bello, BDS, MS,
Fares S. Al-Sehaibany, BDS;
Joseph O. Adenubi, BDS, MSc, MPH, FMCDS
King Saud University, College of Dentistry, P.O. Box 60569, Riyadh 11545, Kingdom of Saudi Arabia.

This is a study of 1,203 Saudi children aged 2-14 years who presented for treatment at the emergency clinics of four of the main hospitals and three polyclinics in Riyadh during the year 1993 (1413-1414H). The main purpose of the study was to determine the pattern of the dental problems in these Saudi children. Diagnosis showed that 88.7% of the children had dental caries. Chronic dentai abscess was found in 17.1%, while acute periapical infections occurred in 8.0%. Gingivitis and trauma were found in 19.2% and 3.8%, respectively. Crowding occurred in 5.7% while ulcers, discoloured teeth, supernumeraries and hypodontia accounted for the rest. The pattern of treatment required was: restorative (83.7%), extractions (39.1 %), periodontal (18.2%); orthodontics (14.7%) and prosthetics (2.9%). Splinting due to trauma was needed in three of the children. The treatment needs highlight the importance of the need for an early attendance of a child at the dentist for appropriate preventive measures and early treatment when necessary. It is important for the Saudi Ministry of Health to step up the campaign for oral health education to the community, particularly for the expectant and young mothers. The emphasis should be on early visit of a child to the dentist (not later than 12 months), dietary counselling, oral hygiene instructions, the use of fluorides and regular dental check-up.

The same workers found that in Saudi children in Riyadh, 60% of the 6-year-olds, 43% of the 9-year- olds, and 32% of the 12-year-olds had healthy gingiva, thus suggesting an increase in periodontal disease amongst the children with age. Shammery ef a/¹ also reported a dramatic increase in the calculus rate of the same children in Riyadh from 1 % in the 6-year-olds to 9% in the 9-year-olds and 15% in the 12-year-olds. Of the 2,238 children examined in Riyadh, aged 6, 9 and 12 years, findings indicated that malocclusion was absent in 64.43%, while there was a presence of slight malocclusion in 16.98% and severe malocclusion in 18.59%.

These national studies showed that there are problems of dental caries, periodontal disease and malocclusion among Saudi children. A little earlier, Al-Seikat and Nasser² reported that 68% of the children in Riyadh, aged 6-15 years, had dental caries. Then Farsi³ found that extractions in 62.7% of the children throughout the Kingdom were due to dental caries; furthermore, the study also showed that 80% of the extractions performed in the age group 6-12 years was due to caries itself.

Do these epidemiological findings reflect in the nature of complaints or the type of treatment required by the children in Riyadh who present at various hospitals and polyclinics in the city? It might, therefore, be interesting to actually study the types of dental problems presented by children who seek dental treatment in the City of Riyadh. Perhaps, this could be followed by the development of strategies for prevention of these oral diseases.

The purpose of this study was to determine the pattern of dental problems in Saudi children who presented for treatment at the emergency clinics of various health institutions in Riyadh.

The study was carried out on children who presented for treatment at the emergency clinics of various health institutions in the City of Riyadh, Kingdom of Saudi Arabia during the year 1993G (1413-1414H). These institutions were Security Forces Hospital, Riyadh Armed Forces Hospital, King Fahad National Guard Hospital, Riyadh Dental Center, three Polyclinics and the King Saud University College of Dentistry - Darraiyah and Malaz campuses.

For each child, aged between 1 year and 14 years, the management procedure performed by the dentist included recording of a comprehensive medical history, dental history, clinical and radiographic examinations, diagnosis and treatment plan. These were followed by actual treatment of each child and all informations were recorded in the patient's clinical records. Later on, all of these informations were transferred to or recorded in the forms specifically prepared for this study. The data recorded in the special forms included reason for attendance, diagnosis, past medical history and the treatment required. Before the commencement of the study, the dentists and / or pediatric dentists in various health institutions concerned were adequately briefed on how to correctly fill the special forms.
 

At the end of the study, 1,203 Saudi children had been treated at the various clinics for pediatric dental emergencies. There were 642 boys and 561 girls between the age of one and 14 years (Table 1). All results from the different hospitals were pooled together for computerized data analysis.

Reasons for Attendance:

As much as 37.4% of the children seen at the clinics attended because of pain, 29.4% because of the presence of "hole in their teeth" while 10.2% reported due to swelling. Only 13.9% attended in order to have a dental check-up while 5.9% and 4.2% respectively reported due to irregularly arranged teeth and bleeding gum (Table 2).

Mobile teeth (5%), lost filling (3.7%) trauma (3.6%) tooth discoloration (3.6%) and the need for cleaning (3.1 %) were some of the other reasons for attendance. Retained primary teeth, missing teeth, delayed eruption, ulcerated gingiva, halitosis and need for a denture accounted for the rest.

Diagnosis of dental problems:

Caries was found in the primary teeth of 74% of the children and 36.4% of the children presented with caries of the permanent teeth (Table 3). Of all the 1,203 children seen in various hospitals and polyclinics, 1067 (88.7%) had dental caries (Table 4). Gingivitis was found in 19.2%, chronic dental abscess in 17.1%, acute periapical infections in 8%, malocclusion in 5.7% and traumatized teeth in 3.8% of the children.

Types of treatment required:

Figure 1 shows that as much as 83.7% of the children required restorative treatment. Extractions occurred in 39.1% while periodontal treatment was needed in 18.2%. As many as 1 77 children or 14.7% required orthodontic treatment. Only 2.9% required prosthesis while other treatments, such as medications, incision and drainage, accounted for 8.9%. The pattern of treatment required is about equal in both sexes [Fig. 1 ].

Medical History:

Most of the children (87.8%) were in good health with occasional medical defect occurring in 11.2% of all the children seen. These defects include asthma, heart disease, cerebral palsy, rheumatic fever, clefts sickle cell anemia, bleeding disorders and hepatitis (Table 5).

As many as 451 children or 37.4% attended the clinic because they were in pain and 123 of them had swelling. These figures are slightly lower than the study performed at the Royal Belfast Hospital for sick children in which 49% of the children attending its emergency clinic had toothache with or without abscess⁴. The study by Henry⁵ in the USA also showed that the most common type of pediatric dental emergencies is the odontogenic infection. Studies in Glasgow Dental Hospital also reported 55% of the Glasgow schoolchildren seen had toothache.⁶ It is, however, surprising that the symptoms due to caries among the Saudi children seeking treatment is almost as high as those in the advanced countries. This shows dental caries as the main culprit for children's attendance at emergency dental clinics. The amount of discomfort the children suffer suggests urgent needs for oral health education in Riyadh. The population must learn to seek dental treatment even before there is pain.

One thousand and sixty-seven children or 88.7% had dental caries and some of these cases are even complicated by chronic or acute periapical infections. This trend in the prevalence of dental caries in children is supported by earlier studies of Seikat and Nasser² as well as Shammery et aP who had reported an increase in the dental caries in Riyadh and in the Kingdom of Saudi Arabia in general.

Malocclusions including crowding and irregularly arranged teeth were diagnosed in 10.1% of the children. Also 168 or 13% of the children came for check-up and, of this number, only 17 required no treatment other than prophylaxis. This shows that not every child who attended the emergency room had true emergency problem. This is expected, however, because of the availability of dental care to citizens at no cost.

The types of treatment required highlight the significance of early attendance of a child at the dentist for appropriate preventive measures and early treatment as necessary. It would seem important to step up the campaign for oral health education to the expectant and young mothers who should be encouraged to take their children to the dentist at the early age, 12 months at the latest. This will give the dentist or pediatric dentist the opportunity to examine the child early, advise on and commence preventive measures as necessary. The emphasis to the young mothers should be on dietary counselling, oral hygiene instructions, the use of fluorides and the cultivation of the habit of regular dental check-up for the child. In addition, early attendance of the child at the dentist will enable the pediatric dentist to commence supervision of the dentition from the primary through mixed to permanent dentition. There is also a need for the Ministry of Health in Saudi Arabia to step up the campaign for oral health education to the community.

The treatment required for periodontal disease (18.2%) and orthodontics (14.7%) is becoming significant, while the major problem is still dental caries. Oral health education to both parent and child will help improve the periodontal health of the developing child. The number of children who require orthodontic treatment suggests that orthodontic treatment should be more readily available than at present. The medical history reassures that most of the children (87.8%) are in good health.
 

The findings in this study permit us to conclude that eight (8) in every 10 Saudi children seen require restorations; four (4) out of 10 children seen in the clinics require extractions; one (1) in 5 requires periodontal treatment; one (1) in 6 needs orthodontic treatment and one (1) in 30 requires prosthesis.

We are grateful to the Directors and general pediatric dentists of various hospitals for their cooperation in this study. We also wish to thank Dr. Nazeer Khan, Biostatistician, College of Dentistry Research Center, King Saud University who helped in data analysis and to Ms. Gina C. Palaganas for typing the manuscript.