Clinical characteristics associated with decision to extract teeth among Orthodontic patients at MUHAS dental clinic in Tanzania

Abstract

ABSTRACT Background: The decision to extract or not during orthodontic treatment has been among clinicians' most debated subjects, with no common conclusion. However, orthodontic patients always present with clinical characteristics that serve as the basis of decision-making towards extraction or non-extraction of teeth, as part of orthodontic treatment. Aim: This study assessed the clinical characteristics associated with the decision to extract teeth among orthodontic patients at MUHAS dental clinic in Tanzania. Methodology:The study was an analytical cross-sectional design. Participants who were involved in the study were obtained by consecutive sampling techniques from amongst the patients presenting at the MUHAS dental clinic. A structured questionnnaire was used to collect both socidemographic and orthodontic tooth extraction data. Clinical characteristics among patients were obtained through clinical examination, use of orthopantomography, photography and study model analysis. Clinical findings were recorded in special forms, and the obtained information were used by three Orthodontists to decide on orthodontic tooth extraction. Data analysis was performed using Statistical Packages for Social Science (SPSS), Version 27.0. and the level of statistical significance was set at p<0.05, with 95% Confidence Interval (CI). Results: The study involved 100 participants aged 13 years and above, with the majority being 13-22 years old. Of the participants, 40% required orthodontic tooth extraction for their treatment. First premolars were the most selected teeth for extraction, with the prevalence of 28%. Among the participants, 83% had Angle’s Class I malocclusion and 17% had other Classes (Classes II and III). On patients’ profile, 64% had straight and 36% had other facial profiles (convex and concave). Mild crowding of 1-3mm in both jaws was 44% in the maxilla and 52% in the mandible, while moderate to severe crowding of > 4mm was 20% in the maxilla and 17%in the mandible. Most participants had competent lips (94%), while only few (11%) had open bites. Increased overjet and overbite were in 26% and 19% of the participants, respectively. In the adjusted Poisson regression, moderate to severe crowding in the mandible (OR=2.55, 95% Cl (1.13,5.74), p=0.02) and facial profiles (convex and concave) (OR=1.58, 95% Cl (1.01,2.47), p=0.04) were significantly related with the decision for orthodontic tooth extraction. Conclusion: A considerable proportion (40%) of the participants were recommended to undergo tooth extraction during orthodontic treatment. The decision towards tooth extraction during orthodontic treatment, was related to the extent of crowding of the teeth in the mandible, and having a concave or a convex facial profile.