Prevalence Of Attrition Of Mandibular Molars In Diabetic Patients
Faazila Fathima1, G. Maragathavalli2*, Senthil Murugan P3
1 Saveetha Dental College And Hospitals, Saveetha Institute Of Medical and Technical Sciences, Saveetha University, Chennai,600050, India.
2 Professor and Head, Department of Oral Medicine, Saveetha Dental College and Hospitals, Saveetha Institute Of Medical And Technical Sciences, Saveetha University, Chennai, India.
3 Associate Professor, Department of Oral Surgery, Saveetha Dental College and Hospitals, Saveetha Institute Of Medical And Technical Sciences, Saveetha University, Chennai, India.
*Corresponding Author
G. Maragathavalli,
Professor and Head, Department of Oral Medicine, Saveetha Dental College and Hospitals, Saveetha Institute Of Medical And Technical Sciences, Saveetha University, Chennai,
India.
Tel: +91-9445171146
E-mail: drgopalvalli@gmail.com
Received: July 21, 2020; Accepted: August 16, 2020; Published: August 26, 2020
Citation: Faazila Fathima, G. Maragathavalli, Senthil Murugan P. Prevalence Of Attrition Of Mandibular Molars In Diabetic Patients. Int J Dentistry Oral Sci. 2020;S8:02:0015:76-79. doi: dx.doi.org/10.19070/2377-8075-SI02-080015
Copyright: G. Maragathavalli© 2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Diabetes mellitus is considered a leading cause of death due to its microvascular and macrovascular complications. It is the most
common non-communicable disease found in older people.Various oral manifestations are associated with diabetes. Tooth wear
which is a progressive condition affects dentition throughout life. It has been accepted as a major oral health problem. Teeth
wear in diabetes patients is to be evaluated to provide early and efficient treatment modalities.This study aims at evaluating the
prevalence of attrition in mandibular molars in diabetic patients. This is a university setting study. 2000 patients who had diabetes
were included in the study. The prevalence of attrition in mandibular molars was evaluated. The data collected was entered in
SPSS and analyzed through Chi square test. It was observed that the majority (60.7% )of the patients with diabetes had attrition in
mandibular molars. Males in the age group of above 50 years showed more attrition when compared to others. Within the limitations
of the study, it can be concluded that prevalence of mandibular molars attrition was significantly high in diabetic patients.
2.Introduction
3.Materials and Methods
4.Results and Discussion/a>
5.Conclusion
6.Author Contribution
7.Acknowledgement
8.References
Keywords
Attrition; Diabetes; Mandibular Molar; Prevalence.
Introduction
WHO has declared diabetes to be a pandemic [1]. It’s prevalence
has increased dramatically over the past few decades. Diabetes
mellitus is considered a leading cause of death due to its microvascular
and macrovascular complications. It is the most common
non-communicable disease found in older people [2]. Growth
hormones and long-term steroids alter the metabolism causing
diabetes. It is also associated with lifestyle disease such as obesity
and sometimes with pregnancy [3, 4]. Oral manifestations in diabetes
include fungal infection,bacterialinfection,oral lesions such
as lichen planus, delayed wound healing, neurosensory oral disorders,
dental caries and tooth loss [5, 6]. Increased manifestation of
dental caries in diabetic patients are either due to increased sugar
update or increased parotid salivary glucose [7, 8]. Periodontitis is
also an important complication of diabetes [9, 10].
Tooth wear is a progressive condition that affects dentition
throughout life. It has been accepted as a major oral health
problem [11]. Tooth wear affects both function and aesthetics.
The most important function affected is eating due to difficulty
in biting and chewing food [12, 13]. Tooth wear includes
attrition,abrasion, erosion and abfraction. Attrition is the loss of
teeth occlusal surface due to the force of tooth against tooth [14].
Treatment of excessive tooth wear is complicated, expensive
and time consuming. Factors related to tooth attrition include
bruxism,chewing patterns etc [15, 16]. Patients most at risk of
dental wear have work and sports dehydration, caffeine addiction,
gastroesophageal reflux, asthma, diabetes mellitus and hypertension
[17, 18]. Tooth wear in diabetic patients was due to increased
intake of acidic food stuff and poor lifestyle habits [19]. Tooth
wear can be found in all age groups [20]. However it is more prevalent
and severe in adults and older people [21, 22].
Diabetes being one of the most common diseases, it is necessary
to evaluate the attrition pattern in these individuals. Therefore
this study was conducted to evaluate the prevalence of attrition in mandibular molars in diabetic patients.
Materials and Methods
Study Setting
This is a university setting study conducted in Saveetha dental college
and hospitals. The pros of the study includes flexibility, ease
of data collection and less time consumption. Cons of the study
includes limited to certain demographics and limited study sample.
Population selection was random. 2000 patients with diabetes
were selected. Approval was obtained from the institutional study
committee.The ethical approval number for the present study is
SDC/SIHEC/2020/DIASDATA/0619-0320. Two examiners
were involved in the study.
Sampling
It is a retrospective study. A total of 2000 case sheets were reviewed.
Cross verification of data for error was done by presence
of additional reviewers and by photographic evaluation. Simple
random sampling was done to minimize sampling bias. It was
generalized to the south Indian population. After reviewing 2000
case sheets, which were then filtered based on required data ,the
final sample size was 1199 diabetic patients.
Data Collection
Data of patients who reported to Saveetha Dental College and
Hospital between June 2019 to March 2020 were reviewed from
the hospital management system which has records of all patient
details. The data was entered in the system in a methodical manner.
For the present study data of diabetic patients was filtered.
Photographs and dental status of these patients were evaluated
to find the prevalence of attrition in mandibular molars. The data
was then entered in excel manually and imported to SPSS for analysis.
Incomplete or censored data was excluded from the study.
Analytics
IBM SPSS software was used for data analysis. Independent variables
included age, gender and diabetes. Dependent variables included
attrition. Descriptive and inferential statistics were used.
Descriptive statistics included frequency of distribution and inferential
statistics included Chi square test.
Results and Discussion
The prevalence of attrition in mandibular molars was significantly
high in diabetic patients. It was observed predominantly in
the older age group(figure1). In the age group of 20 to 35 years,
3.25% of the diabetic patients had attrition in mandibular molars.
In the age group of 36 to 50 years and above 50 years the prevalence
of attrition in mandibular molars was 22.8% and 34.6%
respectively. P value was 0.732 hence proving that association of
prevalence of attrition among diabetic patients in different age
groups is statistically not significant(P>0.05). The study population
consisted of 694 males and 505 females. Mandibular molars
attrition was present in 62.4% of the male diabetic patients and
58.5% in the female diabetic patients.This shows that males had
more prevalence of attrition compared to females.(figure2). P
value was 0.164 hence proving that association of prevalence of
attrition among male and female diabetic patients is statistically
not significant(P>0.05). It was observed that out of 1199 patients,
728 of them had attrition in mandibular molars. Only 39.2% of
the study population did not have attrition in lower molars (figure3).
In a study done in Thailand including 179 diabetic patients within
the age group of 35–74 years, the most prevalent type of tooth
wear was attrition (99.4%) [23]. In another study by de Carvalho
Sales-Peres et al. done in patients with eating disorders, the
first permanent molar was found to have significant tooth wear
when compared to other teeth [24]. Study done by Venugopal
[25], found the prevalence of attrition to be 93.6%. In the current
study, the prevalence of mandibular attrition is 61%.
In accordance with the current study, previous studies also
showed a similar increased prevalence of tooth wear in males [26,
27]. This can be explained by increased bite force in males than
in females [28].
In a study by Bhatnagar and Gnanasundararn [29] in 2009 done in
diabetic patients from Chennai population, the first molar showed
to have significant tooth wear; however, this was explained by the
common period of development of tooth germ of the first molar
and the epithelial cells of pancreas [30-32]. Venugopal et al found
in their study, the prevalence of attrition in the upper and lower
molars to be more common [25].
Figure 1. Bar graph shows the number of patients based on gender. It was found that majority of the patients were males (66.2%) whereas the remaining were females (33.8%).
Figure 2. Bar graph shows the distribution of patients based on age groups. Highest number of patients was seen in 41-60 years (66%) followed by >61 years with 20.68% and finally 17-40 years with 13.32%.
Figure 3. Bar graph shows the frequency of the number of affected molars with furcation involvement. 45% of the affected molars have a Grade II furcation involvement, 35.40% of the affected molars have a Grade I furcation involvement, 15.60% have a Grade III furcation involvement and the least is Grade IV furcation involvement with 4% of affected molars.
Similar to the present study,several other studies also found that the severity of tooth wear increased when age increased [22, 33].
The most common complaint caused due to tooth wear is hypersensitivity and associated poor appearance, despite the presence of advanced tooth wear,patients do not complain of pain due to secondary dentin deposition [34]. Severe loss of tooth causes the loss of vertical dimension and can cause temporomandibulardisorders [35]. This should be intervened at an early stage.The exact reason behind the increased intensity of tooth wear in the diabetic patients is unknown.It is essential to prevent the possible complications such as pulpal pain and temporomandibular joint pain at an early age.
This study could pave way for more research to be done to evaluate the teeth wear patterns in diabetic individuals so that early intervention and successful treatment outcomes can be achieved. The limitations of this study include limited to certain demographics and limited study sample.
Conclusion
Within the limitations of the study, prevalence of mandibular molar
attrition was found to be significantly high in diabetic patients.
Males above 50 years of age showed increased prevalence of attrition.
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