Prevalence of Acrylic Removable Partial Dentures among Adult Patients Attending Public Dental Clinics in Dar-es-Salaam, Tanzania

INTRODUCTION

Tooth loss has not only been associated with the sequelae of oral diseases¹ but has also been linked to sociodemographic, behavioral, or medical factors.^2–4 Following tooth loss, restoration of a partial edentulous mouth may be done using a variety of treatment options,⁵ one such option is a removable partial denture. Removable prosthesis serves to restore the missing teeth and alveolar bone after tooth loss and plays a role in restoring functions of aesthetics, mastication, and speech.⁶ The denture base of the removable partial denture can be fabricated using metal alloy or acrylic resin.⁷ Metal-based removable partial denture is more expensive and technically more demanding and impacts a higher success rate.⁸ On the other hand, acrylic-based removable partial dentures (ARPDs) are not technically demanding and cost-effective making them feasible as a predictable treatment choice in clinical dentistry.⁹ Furthermore, as an interim treatment option, ARPDs are indispensable for aesthetic relief and basic functionality before fixation of permanent dentures.⁹ Other factors that promote its use are the resemblance to gingiva color, not being toxic,¹⁰ and being easy to fabricate and alter if further tooth loss occurs.¹¹ However, the prevalence of ARPD use is determined not only by sociodemographic factors^12–14 but by jaw affected^15,16 and number of teeth replaced.¹⁶

ARPDs are considered a low-cost treatment option for tooth loss in several other countries,^17,18 as in Tanzania.¹⁹ Tooth loss in Tanzania has been previously reported^20,21 with a higher percentage of subjects being partially dentate.²² A very low number of subjects with dentures²³ have been reported; however, information on denture wearing experience, jaw affected, and number of teeth replaced was lacking. The purpose of the study was thus to determine the prevalence of ARPDs among patients attending public dental clinics in Dar-es-Salaam, Tanzania. Data obtained from this study can be relevant, in particular to those involved in planning and organizing healthcare especially oral health rehabilitative services and oral health education on management of tooth loss. This study also provides baseline data for comparative studies locally and internationally on prevalence of ARPDs, denture wearing experience, jaw affected, and number of teeth replaced.

MATERIALS AND METHODS

This hospital-based cross-sectional study was conducted in Dar-es-Salaam, one of the highly populated cities of Tanzania with a population of 4,364,541 million people originating from all over the country.²⁴ At the time of the study, the city of Dar-es-Salaam had three municipals, namely, Ilala, Kinondoni, and Temeke. Facilities providing dental services in these municipalities were Amana, Mnazi Moja, Sinza, Magomeni, Temeke, and Muhimbili National Hospital (MNH). MNH is within the Ilala Municipality, and being a national hospital, it receives patients referred from within the city and all over the country (Fig. 1).

The estimated sample size of 384 attending patients wearing acrylic removable partial was determined using sample size determination formula for proportions [n = z ² p(1 − p)/e ²], where, n = sample size; z = standardized deviation (z = 1.96) for 95% confidence interval; p = being a baseline study, proportion of attending patients wearing acrylic removable partial was estimated at 50% (0.50); ε = marginal error = 0.05.

This was a two-stage sampling procedure. The first stage was visiting respective municipal councils and with their assistance dental clinics to be included in this study were selected.

The second stage included selection of attending participants aged 18 years and above attending each dental facility during the study period. Registered patients who consented were included in the study. Excluded from the study were the very ill and mentally challenged patients.

Following consent and prior to a clinical assessment, patient’s information on registration number, age, and sex was obtained using their hospital registration form. Additional information on level of education and denture wearing experience was obtained from patients and clinical assessment determined affected jaw number of teeth replaced. Obtained findings were recorded in a modified version of the WHO oral health assessment form for adults.²⁵

Obtained information of patients age was grouped into 18–35 years (young adults = 0) and ≥36 years (middle aged and older adults = 1), while sex of the patients was recorded as male = 0 or female = 1. Location of dental facility was further grouped by municipality, Ilala Municipal (Amana and Mnazi Moja = 1); Kinondoni Municipality (Sinza and Magomeni = 2); Temeke Municipality (Temeke = 3), and being a referral hospital, MNH was grouped independently (MNH = 0). Level of education was categorized into primary and lower level of education = 0 and secondary and higher level of education = 1; wearing of ARPDs (without ARPDs = 0 and with ARPDs = 1), denture wearing experience (less than 2 years = 0, 2–5 years = 1 and more than 5 years = 2), affected jaw (upper = 0, lower = 1 or both = 2), and total number of teeth replaced (1–5 replaced teeth = 0 and 6 or more replaced teeth = 1).

Prior to the study, calibration of the examiner (AEK) was done by an experienced examiner (LCC) using 10 patients wearing dentures attending the Muhimbili University dental clinic. Intra examiners’ consistency was assessed during the study by recalling five randomly selected subjects at each of the six dental facilities wearing ARPDs. Kappa values showed perfect agreement of 1.00 for scoring of level of education, total number of teeth replaced, affected jaw and denture wearing experience.

All the gathered data were entered in a computer using Statistical Package for Social Sciences (SPSS, version 20.0, Chicago, Illinois). Collected data were analyzed, and using frequency tables, the distribution of subjects by demographic variables was determined. The prevalence of ARPDs among attending patients at public dental clinics in Dar-es-Salaam by age, sex, and location of dental facility was also determined. Chi-square test at a statistically significant p-value of 0.05 was used to further determine prevalence of ARPDs by demographic variables and with denture wearing experience, affected jaw, and total number of teeth replaced. Ethical clearance for this study was obtained from the Ethical Clearance Committee of the Muhimbili University of Health and Allied Sciences.

RESULTS

A total of 3,225 attending dental patients aged 18–87 years formed the study population with a mean age of 38.39 ± 13.83. Age-group 36–87 years (middle aged and older adults) had the highest number of participants (n = 1,687; 52.3%), and there were many more females (n = 1,688; 52.3%) than males (n = 1,537; 47.7%). Kinondoni Municipality had the highest number of attending patients (n = 1,121; 34.8%) (Table 1).

Table 2 shows the distribution of attending patients with and without ARPDs by age, sex, and location of dental facility. Of the 3,225 subjects, only 339 (10.5%) had ARPDs. There was no statistically significant difference between attending patients with or without ARPDs by age, sex, or location of dental facility.

Shown in Table 3 is the distribution of denture wearing experience of patients with ARPDs by age, sex, and hospital. Denture wearing experience of less than 2 years was statistically significantly higher among younger patients (age-group 18–35) and among those with secondary or higher level of education (p <0.05). Although not statistically significant, denture wearing experience of less than 2 years was higher among males and patients in Kinondoni Municipality (p >0.05).

The distribution of ARPDs in different jaws among patients by age, sex, and location of dental facility is shown in Table 4. ARPDs in the upper jaw were statistically significantly higher among younger adults (n = 102; 63.8%), while ARPDs in both jaws were higher among middle aged and older adults (χ² = 58.270; p = 0.001). ARPDs in the upper jaw were statistically significantly more among males (χ² = 7.097; p = 0.029) and those with secondary or higher level of education (χ² = 11.864; p = 0.003). ARPDs in upper, lower, or both jaws showed no statistically significant difference with location of dental facility (p >0.05).

Shown in Table 5 is the distribution of number of replaced teeth in ARPDs among patients by age, sex, and location of dental facility. ARPDs replacing between 1 and 5 teeth were statistically significantly higher among subjects of young adults (n = 150; 93.8%) and those with secondary or higher level of education (n = 160; 79.2%). Although ARPDs replacing between 1 and 5 teeth were higher among female subjects and among attendees of most facilities, the difference was not statistically significant (p >0.05).

DISCUSSION

This hospital-based cross-sectional study determined the prevalence of ARPDs among patients attending public dental clinics in Dar-es-Salaam, Tanzania. The two-stage convenient sampling method employed in this study was considered in terms of its limitations, and efforts were made to reduce the effect of bias on the expected outcome. Since Dar-es-Salaam has people originating from all over the country,²⁴ it can be assumed that these results are representative of Tanzania. Furthermore, being a hospital-based study, generalization of these results should be made with caution as ARPDs captured did not include all adults with ARPDs. Although information obtained is at one point in time, the data set provides baseline data that can be used for comparative studies locally and internationally.

In accordance with hospital-based studies previously conducted in Tanzania, this study also found that middle aged and older adults attended dental facilities more than the younger adults and many more were females compared to males.^26,27 This study also reports that Kinondoni Municipality hospitals had the highest number of dental attendees, and this observation could be related to Kinondoni Municipality having the highest population in comparison to other municipalities in Dar-es-Salaam.²⁴

The prevalence of 10.5% of subjects with ARPDs in this study was similar to a previous study done in Dar-es-Salaam²³ but lower than the 24.3% of patients who received ARPDs in Kosova.⁸ Contrastingly, an even higher prevalence of subjects with ARPDs was reported in Saudi Arabia⁷ and in Khartoum State.²⁸ Differences in the reported prevalence of subjects with ARPDs could be related to lack of insurance or financial limitations.²⁸

Contrasting to findings from this study that observed no statistically significant difference of wearing of ARPDs by age, studies done in Seuneubok District, West Aceh²⁹ and Saudi Arabia⁷ reported many more partial denture users of age 41 years and above. In addition, the statistically significantly higher proportion of younger age-group wearing ARPDs replacing lesser number of teeth observed in this study was similar to findings reported in Hungary³⁰ and Kosova.⁸ Contrastingly, another study reported that ARPDs replacing higher number of teeth were observed to increase with age.³¹ The lesser number of teeth replaced among the younger age-group in this study could be related to shorter sequalae of diseases¹ in comparison to the older age-group who may have delayed seeking treatment.³²

Although other studies have reported on the influence of level of education on denture use,^32,33 level of education in this study was observed not to have an influence on prevalence of ARPDs. In addition, the statistically significantly higher number of subjects in this study having secondary or higher level of education and ARPDs replacing between 1 and 5 teeth could be related to increased awareness on oral health.²⁸ While the negative influence of low educational level has been associated with edentulism,³⁴ a higher level of education provides employment opportunities and societal recognition which may be the explanation why many more participants restored their missing upper dentition.⁷

In disagreement with findings from this study that found ARPDs in the upper jaw statistically significantly higher in young adults, other studies report a higher prevalence of younger adults wearing ARPDs in the lower jaw.^8,35 However, prevalence of ARPDs in the both jaws was observed more among the middle aged and older adults in this study as in accordance with a study done in Khartoum State.²⁸ Although a previous study reported that males are less concerned about their edentulism, less likely to opt for restorations and less likely to visit a dentist than females,³⁶ this study found a statistically significantly higher proportion of males having ARPD’s in the upper jaw. A study done in Nigeria also reported that more males compared to females requested for upper dentures.³⁷ It is possible that males had more tooth extractions than females due to different other causes of tooth loss like interpersonal violence and motor accidents.³⁸

Previous studies done in Tanzania^20,23 reported tooth loss among the middle-aged and older adults and a denture wearing experience of more than 2 years and replacing more than five teeth was also reported among middle aged and older adults in this study. In line with another study that reported education level to be associated with socioeconomic status and health outcomes,³⁹ many more subjects with primary and lower level of education in this study had a denture wearing experience of 2 or more years. The cumulative effect of tooth loss over long period of “wait-and-see”³² and the fact that faulty ARPDs can lead to rapid loss of remaining teeth^40,41 could explain the observed findings.

CONCLUSION

The prevalence of ARPDs among attending dental patients was low (10.5%) with a denture wearing experience of less than 2 years being higher among younger age-group and those with secondary or higher level of education. ARPDs in the upper jaw were related to being young, male, and having secondary or higher level of education, while replacement of 1–5 teeth was related to being young and having secondary or higher level of education. Community awareness on use of ARPDs in management of tooth loss should be emphasized.

ACKNOWLEDGMENT

Authors would like to thank The Tanzania Ministry of Health, Community Development, Gender, Elderly and Children is acknowledged for the provided financial support, Muhimbili University of Health and Allied Sciences, authorities of the dental facilities and participants for making this work possible.

ORCID

Lorna C Carneiro https://orcid.org/0000-0001-9015-3155

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