|Year : 2016 | Volume
| Issue : 4 | Page : 220-226
Trends in dental treatment of children at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Joycelyn Odegua Eigbobo, Sylvia S Etim
Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria
|Date of Web Publication||21-Dec-2016|
Joycelyn Odegua Eigbobo
Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt 500001, Rivers State
Background: Utilization of oral health services by children is dependent on factors related to the children, parents, and health facilities. Availability of dental personnel (skills) and facilities are very essential for optimal dental care. The aim was to assess the trends in service provision to child dental patients at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Materials and Methods: A 5 years (2009-2013) retrospective review of clinical records of pediatric dental patients aged 0-16 years was carried out at the Child Dental Health Clinic of the University of Port Harcourt Teaching Hospital, Port Harcourt. The following information was obtained from the records: (i) The period of the procedures, (ii) demographic characteristics, and (iii) the procedures done. The information was collated and analyzed using the SPSS version 20. Results: There were 1692 children treated during the study period; comprising 905 (53.5%) females and 787 (46.5%) male and their mean age was 8.4 (±3.9) years. Most (550 [31.2%]) of the dental procedures were carried out in 2013. In the study period, March and April had the least (4.3%) and most (11.5%) dental procedures, respectively. Tooth extractions and minor surgical procedures represented one-third (33.3%) of the procedures carried out. Preventive procedures were more frequently performed during school vacations while emergency procedures were done when schools were in session. There was a decline in tooth extractions from 2011 to 2013 while there was an increase in preventive procedures. Conclusion: Dental services were more utilized during school vacations, and there was an increase in utilization of preventive dental procedures as a result of increasing oral health awareness.
Keywords: Dental procedures, Nigerian children, trends, utilization
|How to cite this article:|
Eigbobo JO, Etim SS. Trends in dental treatment of children at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Sahel Med J 2016;19:220-6
|How to cite this URL:|
Eigbobo JO, Etim SS. Trends in dental treatment of children at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria. Sahel Med J [serial online] 2016 [cited 2020 Feb 29];19:220-6. Available from: http://www.smjonline.org/text.asp?2016/19/4/220/196373
| Introduction|| |
"Oral health is very essential in the total wellbeing of a child and adolescent."  Apart from healthy diet and efficient plaque control, regular visits to the dental clinic are essential for good oral health.  Early dental visits have been shown to reduce dental costs since oral diseases are identified and treated early thereby reducing complications. , Preventive, interceptive and curative procedures are essential in achieving optimal oral health, especially when oral diseases are established. These visits may be routine or episodic; episodic visits are as a result of dental emergencies (such as pulpitis, abscesses, and trauma) or symptoms.
Access and utilization of oral health services by children is dependent on factors related to the children, parents, and health facilities. ,,,,,,, Dental personnel (skills) and facilities are very essential for optimal dental care  and the procedures done are dependent on the nature and severity of the oral disease. , Poor utilization of dental services has been reported among Nigerian children; , however, a scholastic trend (i.e., variation with school calendar) was observed among Nigerian children in Ibadan. 
Although studies have been reported on the utilization of oral health services, the trends in the services offered by the dental facility have not been reported among pediatric dental patients in the Tertiary Health Institution in South-South Geo-political zone in Nigeria. Furthermore, the presence of a specialized pediatric dental unit would have an impact on services carried out. This study was therefore carried out to assess the trends in dental treatments from 2009 to 2013 at the University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria.
| Materials and methods|| |
The Dental Center of the University of Port Harcourt Teaching Hospital commenced dental services without specialized departments. However, the dental center has since grown to having five specialized departments (including child dental health) with the commencement of the Dental School, University of Port Harcourt. Furthermore, there has been an increase in the work force as a result of employment of staff and expansion in services: From having just one dental surgery to having 6 other states of the art dental chairs, children's waiting room, and more dental equipment in 2012. A review of the dental records of pediatric patients in the dental clinic from January 2009 to December 2013 was carried out. The following information was obtained from the records:
The information was collated and entered into a data sheet, and the data were analyzed using the Statistical package of Social Sciences version 20 (IBM, Chicago, United States of America). Frequency distribution tables were generated for categorical variables using Chi-square statistics tests at 95% confidence interval, the values of P ≤ 0.05 was considered to be statistically significant.
- Period: The procedures were carried out; months and year
- Demographic characteristics: Age as at the last birthday, the age was further categorized into four groups - Group 1 = 0.1-4 years, Group 2 = 5-8 years, Group 3 = 9-12 years, and Group 4 = 13-16 and gender (male or female)
- Diagnoses of the subjects
- Treatments carried out were categorized as:
- Preventive procedures: Scaling and polishing, professionally applied fluoride, pits and fissure sealants, and curettage
- Restorative procedures: This was further divided into conservation (pulp capping, glass ionomer cement (GIC) restoration, amalgam filling, composite resin restoration (CRR), and stainless steel crowns), prosthodontics and endodontics (pulpotomy, pulpectomy, apexification, and root canal therapy)
- Tooth extractions and minor surgeries (debridement, suturing soft tissues, frenectomies, operculectomy, splinting, reduction of mandibular fracture, surgical exposure of unerupted tooth, excision, and enucleation).
Permission was sought and obtained from the Research and Ethics Committees of the University of Port Harcourt.
| Results|| |
There were 1692 children treated during the study period; comprising 905 (53.5%) females and 787 (46.5%) males, and the difference was not statistically significant within the study period (P = 0.76, df = 4, χ2 = 1.895 [Figure 1]. The yearly distribution of the patients according to gender is shown in [Figure 1]. Slightly more females were treated in 2011 to 2013.
The age range was between 0.3 and 16 years, with a mean age of 8.4 (± 3.9) years. The majority (49.3%) were the 5-8 years age group [Table 1].
It was observed that a total of 2218 diagnoses were made in the study period, and dental caries and its sequelae were the most (45.9%) frequent diagnoses made followed by chronic marginal gingivitis. There was a decreasing trend in presentation with dental caries from 2009 to 2012 and a slight increase in 2013 while there was an increase in the presentation with chronic marginal gingivitis from 2009 to 2013 [Table 2].
In the study period, the months with the most dental treatments were April (11.5%) and August (11.1%) while the month with the least number of dental treatments was March (4.3%) as shown in [Figure 2].
|Figure 2: Monthly variation of dental treatments during the study period (2009-2013)|
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Tooth extractions were the most frequently carried out procedures in March and November while preventive procedures were more frequent in of July [Figure 3].
|Figure 3: Monthly trends of the different procedures carried out at the child dental clinic during the study period|
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The year with the most treatments was 2013 with 550 (31.2%) subjects while the year with the least procedures was 2009 with 176 (10%) subjects. Altogether 1763 procedures were carried out; tooth extractions and other minor surgical procedures constituted 587 (33.3%) of the treatments while 570 (32.3%) were preventive procedures. The other procedures were tooth conservation (19.1%), endodontic procedures (13.1%), and prosthodontic treatments (0.5%). Initially in the year 2009, tooth extractions were the most frequently carried out procedures; however, there was a declining trend of tooth extractions. It was observed that the proportion of exodontias in 2009-2013 reduced as follows. About 41.5%, 35.4%, 27.2%, 33.2%, and 25.6% of the procedures carried out in the study period [Table 3]; in 2013, a quarter (25.6%) of the procedures were tooth extractions while 30.5% and 32.3% of the patients had scaling and polishing and GIC restorations, respectively.
Preventive procedures in the clinic
Five hundred and seventy (29.6%) children had preventive procedures in the dental clinic; 292 (51.2%) males and 278 (48.8%) females. There was increasing number of patients taking preventive treatments from the year 2009 to 2013. The males 274 (52.8%) had more scaling and polishing than the females in 2009-2012, In the study period, more females had professionally applied topical fluoride and pits and fissure sealants than the males [Table 4].
|Table 4: Proportion of patients with Preventive procedures yearly (2009 - 2013) according to gender |
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Three hundred and seventy-six (19.1%) restorative procedures were carried out, and 222 (60.5%) were done in females while 145 (39.5%) were in males. GIC restorations were the most frequently carried out restorative procedure (9.9%) followed by amalgam restorations (7%), only 2.1% of the procedures were CRRs. Stainless steel restorations were very few and were not carried out before 2013. Amalgam restorations were the most commonly carried out treatments in 2009 and 2010 while GIC restorations were the most frequent procedures in 2011-2013 as shown in [Table 5]. There was a decline in the use of amalgam restorative material in conservative restorations from 69.4% in 2009 to 21.9% in 2013. Prosthodontic treatments were carried out in 9 (0.5%) patients; 5 males and 4 females.
|Table 5: Gender of patients with restorative procedures in the study period (2009 - 2013) |
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Two hundred and thirty (11.9%) endodontic procedures were carried out; 135 (58.7%) females and 95 (41.3%) males. One hundred and twenty (52.2%) were carried out on primary teeth (pulpotomies and pulpectomies). Root canal treatment was carried out in more females (67.9%) than males (32.1%) [Table 6].
|Table 6: Endodontic procedures carried out during the study period according to gender |
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Tooth extractions and other minor surgical procedures
Five hundred and forty-four (28.4%) children; 235 (43.2%) males and 309 (56.8%) females had tooth extractions while 44 (2.3%) minor surgical procedures were carried out. Of these debridement and excision were 0.7% each, frenectomies, surgical exposure, and enucleation were 0.1% each while immobilization was 0.5%. The highest numbers of procedures were carried out in 2013 [Table 7].
|Table 7: Proportion of patients with surgical procedures yearly (2009 - 2013) according to gender |
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| Discussion|| |
More females utilized the child dental services than males during the study period and this is similar to the findings by Denloye et al. but differed from the study in Lagos  where there were more males than females. Although the difference between males and females was not statistically significant, when this was assessed according to age groups there was a statistically significant difference. Most females were in the teenage group and this maybe because the females are becoming more conscious of their health. Most of the patients presented with dental caries and its sequelae, and this was decreasing trend except in 2013 where there was a slight increase. It was observed that almost all the procedures had more females than males except scaling and polishing which had more males; this corroborates the finding of the study done in Lagos, Nigeria.  This may be because males have a poorer oral hygiene than females  or the females were more conscious of their oral health. More tooth extractions were carried out among the females, and this was comparable to the findings in the Lagos study. However, the proportion of females in this study was higher than that reported in Lagos.
There was a scholastic pattern of dental service utilization; in this study, April and August had the highest number of patient attendees. This may be because these months coincided with the school vacations. This was similar to the pattern reported by Osuji where an increase in utilization of service was observed in August.  March had the least number of dental procedures followed closely by November; this possibly was due to the industrial actions by some health workers in these months in the year 2012 and 2013. Furthermore, to a lesser degree, these periods coincided with children's first and second term school examinations, respectively.
It was also observed that more preventive procedures such as scaling and polishing (cleaning) were done during the holidays while dental emergencies were more frequent when the schools were in session. This is expected since the schools were in session, in order not to miss school children's preventive dental visits were delayed till holiday. However, the most carried out procedures were tooth extractions, and there was a declining trend from 2009 to 2013 though there was a slight increase in 2012. This may have been a result of a decline in dental caries presentation, an increased patient awareness and availability of preventive services.
It has been shown that most patients present late to dental clinics ,,, thus extractions or endodontic procedures are carried out instead of conservative restorative procedures. Endodontic procedures are preferred when the teeth are restorable; however, in this study, more tooth extractions were carried out. This may be because the costs of endodontic procedures were higher than that of tooth extractions, so patients opted for the cheaper option. In our study, extractions and endodontic procedures were more frequently carried out in females.
Several reports have shown low patient turnout for routine , and preventive dental visits  with most dental visits as a result of pain. ,,, Another factor could be the behavior and disposition of the child and parent to the dental team and dental procedure generally. , Fear or anxiety prevents patients from coming to receive treatment at an early stage of the oral diseases. ,,, In this study, the females had more tooth extractions and pulp therapies which are an indication of the severity of dental caries.
When compared to other studies, the proportion of patients who were treated for tooth extractions was far higher than that reported in Lagos.  This may be because the oral health awareness in Lagos is better than in Port Harcourt thus, late presentations were not as frequent as in this study; hence, carious teeth could still be restored. In our study, GIC was the most commonly used restorative material in conservative restorative procedures in this center, this probably was because of the child-friendly properties of GIC, which includes biocompatibility, ease of use, fluoride - releasing, and recharging properties. 
From this study, it was observed that the pattern of dental services provided depended on the availability of the dental facility, i.e. dental materials and dental personnel. The increase in patient attendance possibly was as a result of greater manpower, improved facility procurement of dental materials, and improved patient awareness. Expansion in the provision of dental service resulted as an off-shoot of procuring more equipment and employment of more staff in the year 2012. There were oral health awareness programs from the year 2012 this may have also raised the level of dental awareness, reducing oral health misconceptions which consequently resulted in an increase in the utilization of dental services.
| Conclusion|| |
Dental services were more utilized during school vacations, and there was an increase in utilization of preventive dental procedures probably as a result of increasing oral health awareness.
Oral health can be optimal when the facilities, skills, and various dental materials are available. Furthermore, oral health awareness should be improved so that the dental facilities may be better utilized.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General - Executive Summary. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health; 2000.
Amin MS, Perez A, Nyachhyon P. Barriers to utilization of dental services for children among low-income families in Alberta. J Can Dent Assoc 2014;80:e51.
Savage MF, Lee JY, Kotch JB, Vann WF Jr. Early preventive dental visits: Effects on subsequent utilization and costs. Pediatrics 2004;114:e418-23.
Lee JY, Bouwens TJ, Savage MF, Vann WF Jr. Examining the cost-effectiveness of early dental visits. Pediatr Dent 2006;28:102-5.
Scott G, Brodeur JM, Olivier M, Benigeri M. Parental factors associated with regular use of dental services by second-year secondary school students in Quebec. J Can Dent Assoc 2002;68:604-8.
Sote EO. Trends in dental treatment of children at LUTH Nigeria (1988-1998). Nig Q J Hosp Med 2013;13:42-7.
Taiwo OA, Soyele OO, Ndubuizu GU. Pattern of utilization of dental services at Federal Medical Centre, Katsina, Northwest Nigeria. Sahel Med J 2014;17:108-11.
Eklund SA. Trends in dental treatment, 1992 to 2007. J Am Dent Assoc 2010;141:391-9.
Okullo I, Astrøm AN, Haugejorden O. Social inequalities in oral health and in use of oral health care services among adolescents in Uganda. Int J Paediatr Dent 2004;14:326-35.
Eigbobo JO, Onyeaso CO. Maternal knowledge and awareness of factors affecting oral health in the paediatric population. Odontostomatol Trop 2013;36:15-24.
Eigbobo JO, Aikins EA, Onyeaso CO. Knowledge of preventive child oral health care among expectant mothers in Port Harcourt, Nigeria. Pediatr Dent J 2013;23:1-7.
Eigbobo JO, Aikins EA, Onyeaso CO. The spectrum of pulpal diseases and therapies in children in a tertiary centre in Nigeria. Port Harcourt Med J 2013;7:16-23.
Eigbobo JO, Onyeaso CO, Okolo NI. Pattern of presentation of oral health conditions among children at the University of Port Harcourt Teaching Hospital. Brazilian Research in Pediatric Dentistry and Integrated Clinic 2011;11:105-9.
Ajayi DM, Arigbede AO. Barriers to oral health care utilization in Ibadan, South West Nigeria. Afr Health Sci 2012;12:507-13.
Osuji OO. Utilization of dental services by children at the University College Hospital, Ibadan, Nigeria. Odontostomatol Trop 1990;13:97-9.
Denloye OO, Bankole OO, Onyeaso CO. Dental health service utilization by children seen at the University College Hospital-an update. Odontostomatol Trop 2004;27:29-32.
Olanrewaju I, Arowojolu OM, Gbadebo SO, Ibiyemi TS. An audit of pattern of patients' presentation at the periodontics clinic of the University College Hospital, Ibadan. Ann Ib Postgrad Med 2009;7:16-20.
Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: Exploring the interplay behavioural health, service utilisation and dental fear. BMC Oral Health 2007;7:1.
Fotedar S, Sharma KR, Bhardwaj V, Sogi GM. Barriers to the utilization of dental services in Shilma, India. Eur J Gen Dent 2013;2:139-43.
Croll TP, Nicholson JW. Glass ionomer cements in pediatric dentistry: Review of the literature. Pediatr Dent 2002;24:423-9.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]