Partial Edentulism in Patients Visiting the Dental Out-Patient Department at the Tertiary Care Centre in the Eastern Part of Nepal

Introduction: Partial edentulism is an irreversible condition resulting from various dental diseases like dental caries and periodontal lesions. Loss of teeth produces deleterious effects on masticatory function, phonetics, facial appearance and comfort of the patients. If not restored on time, it can lead to pathological changes in vertical dimension, occlusion and temporomandibular joint. Methods: This study was conducted in the department of Prosthodontics, CODS, BPKIHS from September 2015 to March 2016. All patients above the age of 14 years presenting with partial loss of dentition and willing to give informed consent were included in the study. Data regarding age, gender, missing teeth, cause of permanent tooth loss and age of first permanent tooth loss were collected from 750 patients. Results: Dental caries was the major cause of tooth loss accounting for 60.5% of the study population followed by periodontal disease (14.0%) and trauma (11.9%). First permanent tooth loss was highest in the age group of 35-44 years (22.9%). The most common type of partial edentulism was found to be Kennedy’s class III followed by class IV, class I and class II in both the arches. Conclusions: The most common cause of permanent tooth loss was dental caries in the study population. The first permanent tooth loss was found to be highest in age group 35-44 years. The most common type of partial edentulism was the Kennedy's class III in both the arches.


Introduction
P artial edentulism, defi ned as the loss of 1-15 teeth on a jaw, is caused by periodontal diseases, caries, oro-facial trauma and birth defects [1][2][3][4][5] . Edentulism is associated with low income, poor oral hygiene and dietary habits, use of tobacco and alcohol, illiteracy and inadequate oral health services 4,6,7 . Long term partial edentulism leads to occlusal discrepancies, tooth migration, and temporomandibular joint disorders. It also can lead to low intake of fruits and vegetables in-turn aff ecting general health and quality of life. 5,8 Etiology of partial edentulism in our region is not well documented. Knowing the etiology of partial edentulism helps in identifying preventive strategies and prosthetic needs.
The present study aims to identify the causes of permanent tooth loss, age of fi rst permanent tooth loss, and type of partial edentulism present in patients visiting the dental OPD of tertiary care centre in Eastern Nepal.

Methods
This cross sectional study was conducted in the department of Prosthodontics, CODS, BPKIHS from September 2015 to March 2016. All patients above the age of 14 years reporting to the department presenting with partial loss of dentition were invited to participate in the study.
Those willing to participate were required to sign informed consent. The data regarding age, gender, missing teeth, cause of permanent tooth loss and age of fi rst permanent tooth loss were collected from 750 patients using structured data collection form. Inclusion criteria were partially edentulous patients with age above 14 years. An exclusion criterion was patients not willing to give written informed consent. Consecutive sampling technique was followed and the sample size was calculated as 750.

Methodology
All patients reporting to the department of Prosthodontics presenting with partial loss of dentition within the study period of fi ve months were taken as sampling unit. The participants were explained about the study by the principal investigator and written informed consent was obtained. A brief history was taken and recorded in the case record sheet followed by clinical examination. The fi ndings were then entered in the work proforma. Training and calibration of the examiner were done in the department prior to the start of the study. At the end of stipulated time period, the data were entered into a Microsoft 2007 Excel sheet and descriptive statistical analysis was done using SPSS version 11.5 by age, gender, type of partial edentulism and cause and age of fi rst permanent tooth loss.
66% of the study population has partial edentulism present in the mandibular arch. The most common type of partial edentulism present in the mandibular arch was found to be Kennedy's class III (21.3%) followed by class III modifi cation 1 (10.9%), class IV (9.9%), class I (8.7%), class II (5.6%). (Table 3, Table 4)

Discussion
This study revealed that partial edentulism was more common in females than in males which is consistent with the study carried out by Abdurahiman VT et al, Naveed H et al, Sapkota B et al, Patel JY et al. [9][10][11][12] Main cause of tooth loss was found to be dental caries (60.5%) followed by periodontal disease   13,14 First permanent tooth loss was found to be maximum in the age group of 35-44 years (22.9%). This could be due to lack of awareness about dental diseases and consequences of tooth loss, inability to aff ord the cost of treatment and lack of motivation to save teeth and unavailability of treatment facilities. Mandibular arch (66%) was aff ected more than the maxillary arch (60%) which is consistent with fi ndings of other studies 10,12,15 . Mandibular fi rst molar is the fi rst permanent tooth to erupt in the oral cavity at the age of around 6 years. Therefore it is the most aff ected tooth in the oral cavity.

Limitation of this study
The main limitation of this study is that the study population is not representative of the general population since we recruited subjects from patients already attending a dental OPD. Hence the results may not be a true indication of distribution of pattern partial edentulism in the Nepalese population. Future studies should address this gap and also explore the subject's socioeconomic indictors, access to health care and attitude towards dental treatments.

Conclusions
The most common cause of permanent tooth loss was dental caries and fi rst permanent tooth loss was highest in age group of 35-44 years(22.9%).
Mandibular arch was more aff ected than the maxillary arch. The most common type of partial edentulism was Kennedy's class III and least common was Kennedy's class II in both the arches.