|Year : 2016 | Volume
| Issue : 1 | Page : 38-43
Reasons for seeking dental healthcare services in a Nigerian missionary hospital
Oseremen Gabriel Ogbebor1, Clement Chinedu Azodo2
1 Department of Oral Diagnosis and Radiology, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
2 Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria
|Date of Web Publication||6-May-2016|
Clement Chinedu Azodo
Department of Periodontics, Prof. Ejide Dental Complex, University of Benin Teaching Hospital, Room 21, 2nd Floor, P.M.B. 1111 Ugbowo, Benin City, Edo State
Objective: To determine the reasons for seeking dental healthcare services in a missionary hospital in Benin City, Nigeria. Materials and Methods: This 14-month retrospective study was conducted in a Pentecostal missionary hospital in Benin City. Data of interest which included age, gender, occupation, primary presenting complaints, and primary diagnosis were collected from the case notes with self-designed proforma. Cases with incomplete data were excluded from this study. The obtained data were subjected to descriptive statistics in the form of frequencies, cross tabulations, and percentages using Statistical Package for the Social Sciences version 17.0. Results: A total of 613 cases were retrieved with the complete information. The majority (56.3%) of the patients were young adults (18-40 years). About one-fifth (21.2%) of the patients were middle-aged adults. Children and elderly constituted 15.8% and 6.7% of the patients, respectively. A total of 332 (54.2%) patients were females. There was diversity in the occupation of the patients with about one-third (37.7%) of the patients being students. The majority of the patients had toothache as their primary presenting complaint (71.1%). Others were tooth deposits (6.0%), fractured teeth (3.8%), hole in teeth (3.1%), missing teeth for replacement (2.3%), routine dental check-up (2.3%), and mouth odor (2.0%). Diagnosis of dental caries and its complications was made in more than half (58.6%) of the patients while one-fifth (20.4%) of the patients were diagnosed with gingivitis. Conclusion: Data from this study revealed that these enormous diverse patients of a Nigerian missionary hospital had toothache as their main primary presenting complaint and dental caries and its complication as their main primary diagnosis.
Keywords: Dental healthcare, missionary hospital, oral problems, presenting complaints
|How to cite this article:|
Ogbebor OG, Azodo CC. Reasons for seeking dental healthcare services in a Nigerian missionary hospital. Sahel Med J 2016;19:38-43
| Introduction|| |
Early foreign Christian missionaries to Nigeria came with the ministry, school, and hospital which offered spiritual care, education, and health services, respectively. This package has been adopted by the indigenous Christian missionaries in Nigeria with some improvements. For instance, the educational package has been extended to include tertiary education while health services have been upgraded to comprehensive health services in hospital settings, nursing homes, training institutions for different levels of health-care professionals, short-term free community medical and dental health-care services. 
The literature shows that modern dentistry in Nigeria owed much of its origin to the Christian missions particularly the Baptist Mission, Sudan Interior Mission, the Seventh Day Adventist, and the Roman Catholic.  They also contributed significantly to the provision of oral healthcare from the beginning of the 20 th century till date. 
In recent times, the provision of healthcare services by missionaries and nongovernmental organizations have improved healthcare access especially dental healthcare which is burdened with the inequitable distribution. The rising prevalence of oral diseases in government dental healthcare settings with resultant prolonged patient waiting-time may motivate such patients to seek care in missionary and private-owned dental health-care settings. Anecdotal evidence shows that missionary healthcare setting provides more dental healthcare services to different categories of the population, because of the lesser cost of dental care compared to the private clinics. However, there is a paucity of information on the reasons for seeking dental healthcare services in missionary hospital as most of the available studies were conducted mainly in government-owned dental health-care setting. ,,,,
In Benin City, primary, secondary, and tertiary dental healthcare services are available in teaching hospitals, specialist hospitals, medical centers, and private clinics owned by the Federal Government, State Government, Christian Mission, and Individual Specialist and Dental Practitioners, respectively. Benin City is the capital of Edo State, one of the 36 states that make up Nigeria. The residents are of different indigenous and nonindigenous ethnic groups. The common language spoken in hospitals which is understandable to literate and illiterate ethnic groups is Pidgin English, which enhances patients' ability to communicate with the doctors. The objective of the study was to determine the reasons for seeking dental healthcare services in a missionary hospital in Benin City, Nigeria.
| Materials and methods|| |
Ethical approval was obtained from the Ethics and Research Committee of the Pentecostal missionary hospital in Benin City, before commencing the study which was retrospective by design. The dental clinic was manned by two  nonspecialist general dental practitioners during the period of the review (May, 2009 to July, 2010) which was 14 months. The data of interest which included age, gender, occupation, primary presenting complaints, and primary diagnosis were collected from the case notes with self-designed proforma. Inclusion criterion was cases with complete data while exclusion criterion was cases with incomplete data. The obtained data were subjected to descriptive statistics in the form of frequencies, cross tabulations, and percentages using Statistical Package for the Social Sciences version 17.0. (SPSS, Inc., Chicago, IL, USA). Test for significance was done with Chi-square test with P < 0.05 considered as significant at 95% confidence interval. For the purpose of analysis, the age of the patients was categorized into childhood (0-17 years), young adulthood (18-40 years), middle-aged (41-64 years), and elderly (≥65 years) to help highlight the clinical implications of the study.
| Results|| |
A total of 613 cases with complete information were retrieved from the hospital records. The majority (56.3%) of the patients were young adults. About one-fifth (21.2%) of the patients were middle-aged adults. Children and elderly constituted 15.8% and 6.7% of the patients respectively. The majority (97.9%) of the patients were Christians (n = 600), 1.1% were Muslims, and 1.0% were African traditional worshippers. A total of 332 patients were females (54.2%), while 281 of them were males (45.8%). The male and female patients were not significantly different in their age distribution (P = 0.186) [Table 1]. There was diversity in the occupation of the patients with about one-third (37.7%) of the patients being students and one in every five patients (19.4%) was involved in one form of business or the other [Table 2]. Toothache constituted majority (71.1%) of the primary presenting complaints while others in descending order were tooth deposits, fractured teeth, holes in teeth, replacement of missing teeth, routine dental check-up, mouth odor, sensitive teeth, shaking teeth, and bleeding gums. According to the age distribution of presenting complaint, children had more toothache, hole on teeth, bleeding gums, bulging gums, oral swelling, and discolored teeth. In young adulthood, the complaints were mostly routine dental check-up, trauma, and desire to tie their teeth for weight reduction. In middle-aged adults, the most common complaints included tooth deposit swollen teeth/gum, failed amalgam filling, dryness of mouth and swallowed denture. Elderly reported more fractured teeth, missing teeth, mouth odor, sensitive teeth, shaking teeth and facial pain. Male patients had more toothache, deposit on teeth, fractured teeth, routine dental check-up, mouth odor, sensitive teeth, shaking teeth, facial pain, bulging gum, failed amalgam filling, discolored teeth, swallowed denture and growth as their primary presenting complaints while female patients had more hole on the teeth, missing teeth, sensitive teeth, bleeding gum, swollen gum/teeth, trauma, and dry mouth as their primary presenting complaints [Table 3]. More than half (58.6%) of the diagnosis was dental caries and its complications, and about one-fifth (20.2%) of the primary diagnosis was gingivitis. Other main primary diagnosis were periodontitis, fractured teeth, failed bridge, amalgam filling and root canal therapy, pericoronitis, partial edentulism, and oral ulceration [Table 4]. Toothache complaint came mainly from dental caries and its complications, gingivitis, periodontitis, fractured teeth, pericoronitis, impacted teeth, and oral ulcers. Complaints of deposits were mainly from patients diagnosed with gingivitis, periodontitis, and caries. Mouth odor was mainly from gingivitis, dental caries, and psychogenic halitosis [Table 5].
|Table 3: Age and gender distribution of primary presenting complaints among the patients |
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|Table 4: Primary diagnosis in relation to age and gender of the patients |
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|Table 5: Primary presenting complaints and diagnosis among the patients |
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| Discussion|| |
A total of 613 cases with complete information were retrieved from the hospital records. The higher distribution of young adults in the dental patient population has been seen in previous studies in other dental healthcare settings in Nigeria such as government owned settings. ,
In this study, more females than males sought dental healthcare services. This finding is in agreement with similar studies on oral health seeking behavior in Southern Nigeria. , However, this contrasted with findings from Northern Nigeria where males rather than females dominated the dental attendance and receipt of dental treatment. , The religious differences between Southern and Northern Nigeria, which are dominated by Christianity and Islam, respectively, may be the explanation as these religious practices influence and undermine female freedom, movement, and empowerment. The three major religious institutions in Nigeria were represented in different proportions among the patients, but Christians dominated. The apathy of seeking treatment in different religious setting may give a clue to the low representation of other religious groups. There was diversity in the occupation of the patients as 37.7% of the patients were students and one in every five patients (19.4%) was involved in one form of business or the other. The diversity in the occupation of the patients is in tandem with the diversity seen in metropolitan cities like Benin City where the studied hospital is located.
There existed an array of presenting complaints and diagnosis among the studied patients which may be connected with their diversity in age, gender, and occupation. The most plausible explanation for the predominant oral diseases (dental caries and periodontal disease) diagnosed may be due to ignorance, low oral health awareness and knowledge, negative oral health attitude, cariogenic dietary pattern, and suboptimal oral health practices. The observation of toothache as the most common reason for seeking dental healthcare services in this missionary hospital is in agreement with reports of other studies citing pain as the most common reason by patients for seeking dental healthcare services. , Toothache complaints were mainly from dental caries and its complications, gingivitis, periodontitis, fractured teeth, pericoronitis, impacted teeth, and oral ulcers. The toothache complaints and dental caries were highest in childhood, supporting the pattern reported by Masiga , in Kenya; a similar developing country like Nigeria. Tooth deposits being the second most common presenting complaints in this study reflects an esthetic demand/need among dental patients in Nigeria. Fractured teeth were the third most common primary presenting complaints among the patients. This was higher in males, elderly, and those in young adulthood. Males are involved in more risky ventures that can result in traumatic dental injuries. Although the fractured teeth were high in young adulthood which is the age of increased physical activity with attendant trauma but the elderly had the highest prevalence of fractured teeth which may be cumulative due to the unmet treatment need over the years. The fourth most common primary presenting complaints among the patients was "hole in the teeth" and this was found to be higher in females and highest in childhood in terms of age distribution. The proportion of patients demanding tooth replacement (2.3%) in this study is similar to that obtained in a previous study by Ukeje et al.  in a Nigerian tertiary dental healthcare setting. The low percentage of patients attending for routine dental check-up connotes the poor preventive dental attendance pattern among Nigerians. This was comparable to 2.6% and lower than 5.7% reported government owned tertiary dental centers in South-west and South-east, geopolitical zones of Nigeria, respectively. , Symptomatic and irregular dental visit has been reported to be more common than preventive dentist visits among Nigerians. This may necessarily be due to ignorance, poor oral health awareness, and poverty. The mouth odor observed in this study was from gingivitis, dental caries, and of psychogenic origin. It was also found that males had more halitosis than females in this study. The fact that the nose gets adapted easily to odor therefore making the genuine mouth odor sufferer to rely on confidants, partner, or friends to inform them about their condition explained this low level of presentation. Shaking teeth accounted for 1.8% of the primary presenting complaints which is an indication of irreversible periodontal diseases, periodontitis. Although the prevalence of shocking tooth sensation and gingival bleeding is high in community surveys in Nigeria, their prevalence were low in the present study. This may be explained by misconceptions of gingival bleeding as being normal and the adaptive behaviors for shocking tooth sensation among the affected individuals. The diagnosis of tooth wear lesions in this study may very well account for these shocking teeth sensations.
The oral ulceration diagnosed was reported as pain by patients and the prevalence in this study was comparable to 1.3% reported by Omoregie and Okoh  in a tertiary dental facility in the same city. The fact that many individuals seek care from laypersons and medical practitioners initially and only attend dental health-care setting latter may explain this low prevalence of oral ulceration. The prevalence of fractured teeth and jaw connotes trauma as a major contributor to factors prompting the patient to seek dental healthcare services in the missionary hospital. The proximity of the hospital to the city center is a contributory explanation as the vicinity of trauma influences healthcare setting attendance for emergency and possibly definitive care. Infections in the form of submandibular abscess and Ludwig angina were low but their association with mortality call for urgency and adequacy of the care in such patients. Dental healthcare services just like other health services may fail due to a variety of clinician and patients factors thereby making patient to revisit the clinician. The failed treatments in the form of failed bridge, amalgam filling, and root canal therapy constituted 1.3% of all the primary diagnosis in this study. Pericoronitis which was highest in childhood and higher in male patients constituted was the fifth most common primary diagnosis among the patients. This usually occurs from impacted teeth but may occur sometimes from erupting teeth. Pericoronitis constituted appreciable toothache presenting complaints, and they are also problematic, discomforting with mortality complication prompting care seeking attention. Complaint of foreign body swallow which was diagnosed swallowed denture emphasizes the need for denture wearer to visit the dentist for relining of loose denture and repair of broken denture to prevent such eventuality.
The finding of this study may have been limited by the retrospective nature of this study which did not allow further elaboration of abstracted information. However, the practice experience of the general dental practitioners in the studied hospital was expected to play a role documenting all the necessary clinical information.
| Conclusion|| |
Data from this study revealed that these diverse patients of a Nigerian missionary hospital had toothache as their main primary presenting complaint and dental caries and its complications as their main primary diagnosis. There is a need to mobilize community health approach in preventing the major oral diseases seen in this study.
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Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]