|Year : 2016 | Volume
| Issue : 2 | Page : 72-76
Characteristics of patients requesting for tooth extraction in a Nigerian secondary health-care setting
Ifueko Patience Osaghae1, Clement Chinedu Azodo2
1 Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria
2 Department of Oral and Maxillofacial Surgery, Central Hospital, Benin City, Edo State, Nigeria
|Date of Web Publication||19-Dec-2016|
Clement Chinedu Azodo
Department of Periodontics, Room 21, 2nd Floor, Prof. Ejide Dental Complex, University of Benin Teaching Hospital, P. M. B. 1111 Ugbowo, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Introduction: Patient desire or preference has been documented as one of the reasons for tooth extraction, but the affected patients have not been properly characterized. The objective of this study was to determine the characteristics of patients requesting for tooth extraction in a Nigerian secondary health-care setting. Materials and Methods: This study was a prospective study of patients attending the Dental Clinic of Central Hospital, Benin City, Edo State, Nigeria. An interviewer-administered questionnaire which elicited information on age, gender, educational status, dental attendance pattern, tooth extraction experience or that of close relative or friend, reasons for tooth extraction request, and awareness of tooth restoration options was the data collection tool. Data analysis was done using the IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA) and P < 0.05 was considered statistically significant. Results: A total of 137 patients aged between 17 and 65 years that met the inclusion criterion were studied. The majority of the patients who requested for tooth extraction were males, aged between 26 years and 65 years, had tertiary education, and had previously visited the dental clinic. A total of 48.9% and 62.0% of the participants had previous tooth extractions and had relatives that have undergone tooth extractions, respectively. Dental visit pattern was significantly associated with tooth extraction experience. The leading reason for requesting for tooth extraction was a permanent stoppage of pain. Age and gender were not significantly associated with the reasons for requesting tooth extraction. Conclusion: Data from this study revealed that adult patients of both genders, varying ages, educational attainments, and dental attendance patterns requested for tooth extraction in the studied Nigerian secondary health-care setting, and their leading reason for the request was a permanent stoppage of pain.
Keywords: Dental treatment, Nigeria, patient request, tooth extraction
|How to cite this article:|
Osaghae IP, Azodo CC. Characteristics of patients requesting for tooth extraction in a Nigerian secondary health-care setting. Indian J Oral Health Res 2016;2:72-6
|How to cite this URL:|
Osaghae IP, Azodo CC. Characteristics of patients requesting for tooth extraction in a Nigerian secondary health-care setting. Indian J Oral Health Res [serial online] 2016 [cited 2018 May 25];2:72-6. Available from: http://www.ijohr.org/text.asp?2016/2/2/72/196103
| Introduction|| |
Patients seek dental health-care services for different reasons among which include pain, bleeding, swelling, unesthetic appearance, and tooth mobility. The expectation of these patients is that the available dental treatment will be tailored to meet their dental needs and demand.
On dental consultation, clinical diagnosis is made from the information gathered through history, clinical examination, and investigation. The tentative dental treatment plan is usually formulated following clinical diagnosis, but the definitive treatment plan is arrived at following the detailed discussion between the attending dentist and the patient. The detailed discussion between the attending dentist and the patient is necessary to acknowledge the patient's rights in treatment decisions.  Modification of the tentative dental treatment plan is usually done after the patient has decided their best treatment option in relation to their financial status and availability for treatment under the guidance of the dentist.
However, some dental patients rather than present their complaint or listen to the professional advice from the dentist, first, demand specific treatment for their complaint. The demanded treatment may be an appropriate or impropriate treatment option for their complaint. In some cases, there is no indication for tooth extraction based on dental criteria, but the patient may request for tooth extraction on a psychopathologic basis which includes fear of dental treatment or because of a mental disorder such as posttraumatic stress disorder, a somatoform pain disorder, or a disorder of body image perception.  It has been reported that patients who request procedures for themselves that will lead to long-term adverse effects on their function and health are educated and helped to fully understand that their request represents substandard treatment  and the attending clinician has the right to refuse the demanded inappropriate treatment after proper evaluation.  However, the development of trust in health-care provider may trigger patient into agreeing with the recommendations offered by the clinician. 
The influential factors in cases where the demand is appropriate are perceived overwhelming nature of the patient's complaint, and experience and opinions of significant others. The demand for tooth extraction by dental patients is expected to be high in developing countries because tooth extraction is the most commonly performed dental procedure in developing countries. Previous studies stated that 33%-38.1% of the respondents that had tooth extraction stated that it was their own decision to have tooth extraction or they suggested it to the dentist. , Patient desire or preference has been documented as one of the reasons for tooth extraction in the literature, but the affected patients have not been properly characterized. ,,, The objective of this study was to determine the characteristics of patients requesting for tooth extraction in a secondary health-care setting in Benin City, Nigeria.
| Materials and methods|| |
The protocol for this study was reviewed and approval granted by the Ministry of Health, Benin City, Edo State, Nigeria. Written informed consent was obtained from the participants. Participation was voluntary, and no incentive was offered.
Study design/study setting
This prospective study was conducted at the Central Hospital, Benin City between February 2012 and October 2014. This secondary health facility is located in the center of the State capital and renders dental services to all categories of the people in the society.
Patients aged 17-year-old and above who presented to the dental clinic with the presenting complaint of "I want to remove (extract) my tooth" were included in this study.
Patients below 17 years, nonconsenting patients, those referred by other dentists, and other caregivers for tooth extraction were excluded from the study.
Every consecutive patient that came to the dental clinic with the presenting complaint of "I want to remove (extract) my tooth" were included in this study until the minimum sample size was achieved.
Data collection tool
Data collection tool was an interviewer-administered questionnaire. The questionnaire elicited information on age, gender, educational status, dental attendance pattern, tooth extraction experience or that of close relative or friend, reasons for tooth extraction request, and awareness of tooth restoration options.
The data were subjected to descriptive and nonparametric statistics using the IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). Statistical significance was set at P < 0.05.
| Results|| |
A total of 137 patients aged between 17 and 65 years that met the inclusion criterion were studied. The majority of the participants were aged between 26 years and 40 years. Males constituted 56.2% of the participants and dominated the 26-40 years age group, but this is not statistically significant [Table 1]. Almost half of the participants had a tertiary level of education and were the first dental clinic attendees. A total of 48.9% and 62.0% of the participants had the previous extractions and had relatives that have undergone tooth extractions, respectively. Older patients had more dental visit frequency and tooth extractions. Dental visit pattern (P = 0.002) and tooth extraction experience (P = 0.000) were associated with aging. The leading reason for requesting for tooth extraction was a permanent stoppage of pain (63.5%). Other reasons which constituted 15.3% include esthetically displeasing appearance (10) (shape , arrangement of tooth , broken tooth , and additional tooth ) masticatory disturbances (3), pain might come back if treated (2), advised by a friend who has had extraction (2) failed restoration (1), and no time for root canal therapy (1). More than half (58.4%) of the participants were aware of tooth restoration option. Age and gender were not significantly associated with reasons for requesting tooth extraction [Table 2]. Dental visit pattern was significantly associated with tooth extraction experience (P = 0.000) [Table 3].
|Table 2: Characteristics of participants requesting for tooth extraction|
Click here to view
|Table 3: Association between dental visit pattern and tooth extraction experience|
Click here to view
| Discussion|| |
This study was set to determine the characteristics of patients requesting for tooth extraction in a secondary health facility in Benin City, Nigeria, studied 137 patients aged between 17 and 65 years between February 2012 and October 2014. The older patients constituted more than two-thirds of the population, and this may be explained by the fact that the young- and middle-aged adult Nigerians demand immediate resolution of health issues and challenges because of their high-dependency ratio. The usually relax of esthetic importance of teeth with aging is also a contributory explanation for the age distribution.
The self-acclaimed knowledge, persistence and impatient nature, and the firm belief that their demand is right and wise among men may explain why the participants were more males than females. The less consideration of the effect of tooth loss on orofacial esthetic and function may additionally explain why more male constituted more participants than females despite the documented evidence of more dental visit among females than males in Nigeria. ,,,
The availability, accessibility, and affordability of education in metropolitan cities in Nigeria including Benin City explain why majority of the participants had attained secondary and tertiary levels of education. The relatively low- and non-involvement of patients with lower educational attainment in research reported in the literature may also be a contributory explanation.  This study did not observe a significant effect of educational status on patients' request for extraction which contrasted with Klock  report of the significant effect of educational level on patient preference for tooth extraction.
Close to half of the participants making the request for tooth extraction were the first time dental clinic attendee due to the fact that dental visit in Nigeria is commonly problem oriented rather than prevention oriented. The predominance of an episodic problem-oriented pattern of the dental visit in Nigeria explained why majority of the participants that have visited the dentist previously had extraction as their treatment.  This study concurred with this fact as dental visit pattern was significantly associated with tooth extraction experience.
The reasonable proportion of the participants had a close relative that had tooth extraction and close to half of the participants have had tooth extraction who may have informed their opinion about the tooth extraction as a treatment. This may explain why more than a quarter (26.3%) of the participants requested for tooth extraction because they considered it the best treatment option. It was observed that patients aged 26 years and above were found to be regular visitors to the clinic and also had a higher history of previous extractions, but this did not deter them from requesting for further extractions. This contrasts with studies , done in Scotland, where irregular attendance to the dental clinic was a contributor to high tooth morbidity rates.
In this study, 58.8% of the participants were aware of tooth restoration option which was higher than 40.3% reported by Uti and Sofola.  This may be explained by the fact that their study included all patients that had extraction rather than restricting their study participants to only those requesting for tooth extraction. Although the awareness of other treatment options was significantly associated with willingness to have their tooth saved,  the adduced reason why tooth extraction was requested for despite this reasonable awareness of tooth restoration option is due to the presence of pain. Pain on presentation has been cited as the most common reason for not wanting to save teeth.  The request for extraction because of their belief that it is the cheaper treatment option in this study which was also reported by Uti and Sofola.  The economic challenges among a reasonable proportion of Nigerians and economic implication of dental care generally may contribute to this level of tooth extraction request.
The unbearable nature of pain and sleep disturbances have been cited as compelling reasons to visit the dentist  and pain observed to be a major reason (47.2%-64.4%) for tooth extraction in studies. , It is therefore not surprising that the leading reason for requesting for tooth extraction was a permanent stoppage of pain. The permanent stoppage of pain as a reason for tooth extraction request was higher in females than males which explains the lower tendencies of females to tolerate pain than males. It is considered culturally unacceptable for males to openly acknowledge experiencing pain because it is assumed to undermine masculinity. Studies have documented gender effects on pain perceptions which are linked to hormones and cultural beliefs. , Some patients in this study requested for tooth extraction because they believed it is the only treatment for a toothache. This observation is consistent with the study in Pakistan  which reported that the patients because of their traditional belief thought that extraction is the best treatment of diseased teeth.
Esthetic displeasing appearance due to the position or arrangement of the tooth, improperly shaped, and broken tooth were also given as reasons for tooth extraction request. This may be due to the lack of knowledge of the orthodontic treatment of malocclusion and also the long-term consequences of tooth loss. A minor reason for tooth extraction request among the participants was advice by friends because their friends may have had similar problems which were solved by tooth extraction. This is confirmed in a study by Klock  who observed that only 0.4% of patients said that family, friends, or colleagues influenced the decision to have their teeth extracted. It has been reported that patients with bad previous experience of dental treatment, particularly restorative treatment, were more in extraction cases as compared to the nonextraction cases.  This is consistent with our study in which we observed that patients in the 26-40 years age group preferred extraction to other treatment options because they felt it was the best option.
The finding of this study is limited by utilization of convenience sample of consecutively patients requesting for tooth extraction and nondocumentation of the reasons and number of teeth extracted. However, the findings of this study provide a good insight into treatment demand of dental patients and will serve as oral health intervention baseline tool.
| Conclusion|| |
Adult patients of both genders, varying ages, educational attainments, and dental attendance patterns request for tooth extraction in the studied Nigerian secondary health-care setting, and their leading reason for the request was a permanent stoppage of pain.
The abstract of this study was presented at the 3 rd and 4 th Annual Scientific Conference of School of Dentistry, University of Benin, Nigeria, that held in August 2015.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Porter SA, Grey WL. Ethical dilemmas confronting dentists in Queensland, Australia. Aust Dent J 2002;47:241-8.
Broers DL, Brands WG, de Jongh A, Willems DL. Patients with unusual requests for extractions 2. Mental incompetency and psycho-pathologic causes. Ned Tijdschr Tandheelkd 2010;117:547-52.
Chiodo GT, Tolle SW. Cosmetic treatment, autonomy, and risks: "If you don′t do it, I′ll go to a dentist who will." Gen Dent 2001;49:16-8, 20, 22.
Broers DL, Brands WG, Welie JV, de Jongh A. Deciding about patients′ requests for extraction: Ethical and legal guidelines. J Am Dent Assoc 2010;141:195-203.
Chiodo GT, Tolle SW. Treatment recommendations: "Doctor knows best." Gen Dent 2000;48:638-40, 642-4.
Klock KS. Patients′ perceptions of the decision-making process leading to extraction of permanent teeth in Norway. Community Dent Oral Epidemiol 1995;23:165-9.
Uti OG, Sofola OO. Perception of Tooth Extraction as a Treatment Option Among Nigerian. IADR/AADR/CADR 87 th
General Session and Exhibition; 1-4 April, 2009. Available from: https://www.iadr.confex.com/iadr/2009miami/webprogram/Paper119573.html. [Last accessed on 2015 Jun 19].
Reich E, Hiller KA. Reasons for tooth extraction in the Western states of Germany. Community Dent Oral Epidemiol 1993;21:379-83.
McCaul LK, Jenkins WM, Kay EJ. The reasons for extraction of permanent teeth in Scotland: A 15-year follow-up study. Br Dent J 2001;190:658-62.
Anyanechi C, Chukwuneke F. Survey of the reasons for dental extraction in Eastern Nigeria. Ann Med Health Sci Res 2012;2:129-33.
Ajayi EO, Ajayi YO. Utilization of dental services in a population of Nigerian University students. Niger Dent J 2007;15:83-6.
Braimoh OB, Ofili AN. Utilisation of dental services among patients in a tertiary health institution in Nigeria. J Oral Health Community Dent 2013;7:91-4.
Aikins EA, Braimoh OB. Utilization of dental services among civil servants in Port Harcourt, Nigeria. J Dent Res Rev 2015;2:62-6.
Osuh ME, Oke GA, Asuzu MC. Dental services and attitudes towards its regular utilization among civil servants in Ibadan, Nigeria. Ann Ib Postgrad Med 2014;12:7-14.
Okunseri C, Chattopadhyay A, Lugo RI, McGrath C. Pilot survey of oral health-related quality of life: A cross-sectional study of adults in Benin City, Edo State, Nigeria. BMC Oral Health 2005;5:7.
Azodo CC, Ololo O. Toothache among dental patients attending a Nigerian secondary healthcare setting. Stomatologija 2013;15:135-40.
Nuttall NM, Davies JA. The frequency of dental attendance of Scottish dentate adults between 1978 and 1988. Br Dent J 1991;171:161-5.
Kay EJ, Blinkhorn AS. The reasons underlying the extraction of teeth in Scotland. Br Dent J 1986;160:287-90.
Paller CJ, Campbell CM, Edwards RR, Dobs AS. Sex-based differences in pain perception and treatment. Pain Med 2009;10:289-99.
Mogil JS. Sex differences in pain and pain inhibition: Multiple explanations of a controversial phenomenon. Nat Rev Neurosci 2012;13:859-66.
Baloch MU, Shah MA, Ishaque SM, Lahri IA, Naeem M. Factors affecting tooth extraction among adult dental patients in Sandeman Provincial Hospital, Quetta - Pakistan. Pak Oral Dent J 2002;22:153-8.
[Table 1], [Table 2], [Table 3]