Tooth loss, associated factors and prosthetic treatment need among patients receiving methadone maintenance therapy in Dar es Salaam, Tanzania

Abstract

Background Tooth loss is common among the public in Tanzania. It may result from dental caries, periodontal diseases or trauma. Substance use disorder patients are at increased risk of losing teeth due to their altered characteristics of impaired oral hygiene practices, dry mouth and sugar craving. Those characteristics lead to dental caries and periodontal diseases which ultimately may lead to tooth loss. But also Substance use disorder patients are frequently involved in violence and sustain injuries which may lead to tooth loss. Tooth loss has several consequences including; impaired mastication, speech and aesthetics. Tooth loss may be treated by removable and fixed partial dentures, complete dentures or dental implants. The government is investing resources including methadone therapy in the process of treating substance use disorder patients so as to restore their health, but those strategies do not involve oral health services. This may be due to lack of oral health data especially in disadvantaged groups including substance use disorder patients. Findings of this study will provide guidance for the oral health planners and policy makers to plan and implement preventive, curative and rehabilitative oral health care programs for individuals who are affected by substance use. Aim The aim of this study was to determine the prevalence of tooth loss, their associated factors and prosthetic treatment need among substance use disorder patients receiving methadone maintenance therapy in Dar es Salaam. Methodology This was a hospital based cross section study conducted in methadone maintenance therapy clinics in Dar es Salaam involving about 427 study participants. The study period was since December, 2019 to June, 2021. Systematic sampling method was used to obtain study participants. Participants were interviewed using a structured questionnaire and intra orally examined with dental mirror and probe then findings were entered on clinical examination sheet. Study Data was analyzed by using computer system SPSS, version 23. Frequency tables were used to describe the distribution of variables. Proportion, mean and standard deviations were calculated for continuous variables. Chi-square test and student t-test were used to compare proportions and means respectively. Logistic regression analysis was performed to evaluate any association between variables. Statistical significance difference was assumed when p-value was less than 0.05. Results A total of 427 study participant aged 22 to 68 years (mean age = 41 yrs) who attended methadone maintenance therapy clinics in Dar es Salaam were enrolled in this study. Majority of the participants were males (80.8%), aged ≤ 44 years (67.4%) and have primary education or less (61.4%). About 88.8% of study participants have lost one or more teeth, and there is a significant difference of tooth loss between age groups (p=0.001). Mean number of tooth loss among study participants is 8.95, SD = 7.772 and mandibular molars are the most lost teeth (74%) followed by maxillary molars (64.9%) while mandibular canines are the least lost teeth (8.4%) followed by maxillary canines (21.1%). Dental caries is the predominant cause of tooth loss (58.3%) followed by periodontal diseases (39.6%) and traumatic injuries (26.9%). On both jaws, upper and lower, Kennedy class III is dominant (52.5% and 49.8% respectively) while only 6.3% have dental prostheses and acrylic removable partial denture is the leading type of prosthesis on both jaws (upper jaw 81.8% and lower jaw 88.9%). Conclusion Prevalence of tooth loss among substance use disorder patients is high and common causes of tooth loss among these patients are dental caries, periodontal diseases and traumatic injuries. Only small percent of the participants are having dental prosthesis thus prosthetic treatment is highly needed in this particular group