CAUSES AND EFFECTS OF TOOTH LOSS AMONG PATIENTS VISITING KENYATTA NATIONAL HOSPITAL BY ALEX MURERI NTWIGA DDT/41020/2016 MOUNT KENYA UNIVERSITY RESEARCH PROPOSAL SUBMITTED TO THE DEPARTMENT OF DENTAL SCIENCES IN MOUNT KENYA UNIVERSITY FOR THE FULFILLMENT OF A DIPLOMA IN DENTAL TECHNOLOGY 2O18

CAUSES AND EFFECTS OF TOOTH LOSS AMONG PATIENTS
VISITING KENYATTA NATIONAL HOSPITAL
BY
ALEX MURERI NTWIGA
DDT/41020/2016
MOUNT KENYA UNIVERSITY
RESEARCH PROPOSAL SUBMITTED TO THE DEPARTMENT OF DENTAL
SCIENCES IN MOUNT KENYA UNIVERSITY FOR THE FULFILLMENT OF
A DIPLOMA IN DENTAL TECHNOLOGY
2O18
(i)
DECLARATION

DECLARATION
I hereby declare that the study will be my original work unless where knowledged.
NAME: ALEX MURERI NTWIGA
Signature:
Dates:
APPROVAL
This study has been submitted for examination to Mount Kenya University Examination Council
with my approval as the universally students supervisor.
NAME: MR. BERNARD IRUNGU
Signature:
Date:

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DEDICATION
I dedicate this research proposal to the Lord Almighty for unpreceded blessings and support, and
my parents Mr/Mrs Mathew Ntwiga and my siblings Chris,Lilian and Rodgers

ACKNOWLEDGEMENT
I acknowledge my supervisor Mr. Bernard Irungu and the entire departmental lecturers, Mr. James
Mwangi and Mr. Kangogo for their unending support both moraly and spiritually throughout the
duration of pursuing my Diploma in Dental Technology.
Also, not forgetting the other departmental staff for their good job well done in ensuring I gain
knowledge in the field, also to my classmates they’ve really supported me in my studies and off
classroom.

TABLE OF CONTENTS
Declaration…………………………………………………………………………………………
Dedication………………………………………………………………………………………….
Acknowledgement…………………………………………………………………………………
Definition of terms………………………………………………………………………………..
Table of contents………………………………………………………………………………….
Abstract……………………………………………………………………………………………
CHAPTER ONE
1.0 Introduction…………………………………………………………………………………..
1.1 Background information……………………………………………………………………..
1.2 Problem statement……………………………………………………………………………
1.3 Justification of the study……………………………………………………………………..
1.4 Purpose of the study…………………………………………………………………………
1.5 Scope of the study…………………………………………………………………………..
1.6 Study objectives…………………………………………………………………………….
1.6.1 Broad objective……………………………………………………………………………
1.6.2 Specific objectives………………………………………………………………………..
1.7 Hypothesis………………………………………………………………………………….
1.7.1 Null hypothesis…………………………………………………………………………..
CHAPTER TWO
2.0 Literature review…………………………………………………………………………..
CHAPTER THREE
3.0 Research methodology……………………………………………………………………….
3.1 Study site………………………………………………………………………………………
3.2 Study design……………………………………………………………………………………

3.3 Sample population………………………………………………………………………………
3.4 Sampling and sample size……………………………………………………………………..
(v)
3.4.1 Sampling……………………………………………………………………………………
3.4.2 Sample size……………………………………………………………………………………
3.4.3 Sample determination…………………………………………………………………………
3.5 Data collection……………………………………………………………………………………..
3.5.1 Personnel…………………………………………………………………………………………
3.5.2 Operational variables…………………………………………………………………………….
3.5.3 Data collection tools……………………………………………………………………………..
3.6 Inclusion and exclusion criteria……………………………………………………………………
3.6.1 Inclusion criteria…………………………………………………………………………………
3.6.2 Exclusion criteria………………………………………………………………………………..
3.7 Ethical considerations…………………………………………………………………………….
3.8 Data analysis………………………………………………………………………………………
Appendix 1: Time schedule…………………………………………………………………………..
Appendix 2: Budget…………………………………………………………………………………..
Questionnaire………………………………………………………………………………………….
References…………………………………………………………………………………………….

OPERATIONAL DEFINITIONS
KNH……………Kenyatta National Hospital
WHO………………..World Health Organization .

CHAPTER ONE
1.0 INTRODUCTION
1.1 BACKGROUND INFORMATION
Edentulousness is the loss of teeth and can either be partial or complete where partial
edentulousness involves loss of some teeth whereas complete involves loss of all the teeth. A
study done in Palermo in Italy showed that complete edentulousness was present in 4.6% of the
population while partial edentulousness was present in 60.6% of the population. Another study done
in India 2 showed
that 15.6% were completely
edentulous and 54.7% were partially
edentulous.
Causes of edentulousness are broad and may include
dental caries, periodontal
diseases and extractions that could be as a form of traditional practices or due to removal of third
molars,orthodontic treatment or trauma.A study done in 2012 showed that 62% of the
tooth loss in the USA, dental caries topped as the cause of tooth loss with 37.4% followed by a
combination of periodontal disease and dental caries with 12.2%.Another done in Nigeria
showed that the mean tooth loss was 4.5+-7.6 and the major cause of tooth loss was periodontal
diseases with 98.7% then dental caries 0.7% and trauma 0.6% .In Kenya a study done showed
that the mean number of missing teeth in the population was 1.60 .Among those with missing
teeth the mean number of missing teeth was 3.35. Dental caries was the common cause with
52.6% followed by periodontal diseases at 27.6%,extractions as a form of traditional practices
accounted for 12.3%,orthodontic treatment 2.2% and trauma 2.0%.
Effects of tooth loss include loss of width and height of alveoral bone leading to facial changes and
may

lead to social effects .Loss of teeth lead to drifting and supra eruption of the adjacent teeth that
may cause orthodontic problems as well as affect the aesthetics of the patient .These changes
may affect the prospects of future replacements .Other effects include alteration of phonetics and
how one eats and clinical effects may be experienced where other teeth may get affected
depending on how the extraction was done .
Aim of the research is to determine the causes and effects of tooth loss.The research will benefit
both the dental students and patients by helping them understand tooth loss causes and effects
and motivating dentists to give the best treatment possible.
1.2 PROBLEM STATEMENT
Loss of teeth has several causes and the two leading causes are dental caries and periodontal
disease.Loss of teeth affect the quality of life.It has functional limitations.One has difficulty in
phonetics.It lowers the self esteem of a person as well as alter their
facial profile, some even do feel embarrassed.It alters the socialization of a person and the forming
of close bonds.One is limited to the choice of foods and this leads to a compromised nutritional
status in some of these patients and their general health status is affected too.

1.3 JUSTIFICATION OF THE STUDY
Little is known about the causes and effects of loss of teeth in Kenya .This research will help in
determining the causes and effects of tooth loss among patients visiting KNH dental clinic .It will
also benefit dental practisioners by helping them understand the problem and
motivate them to give the best dental treatment to improve the quality of life .

1.4 PURPOSE OF THE STUDY
a) To find out the main causes of lose of teeth among the patients visiting KNH dental clinic
and the measures to put in place curb the the occurances.
b) To raise the awerenss to the general public on the negligence of proper oral hygiene.
c) To raise awereness on the importance of oral appliances either removable or fixed to replace
the missing teeth.

1.5 SCOPE OF THE STUDY
The results of this study will
be used to educate the dentists on the
effects and causes of tooth loss and encourage them to give the best dental treatment to improve
quality of life to the population.

1.6 STUDY OBJECTIVES
To determine the causes and effects of tooth loss among patients visiting the
KNH dental clinic.
1.6.1Specific objectives
1. To determine the causes of tooth loss among edentulous patients visiting KNH dental clinic.
2. To determine the effects of tooth loss among edentulous patients visiting the KNH dental clinic.

1.7 HYPOTHESIS
1.7.1 Null hypothesis
Edentulousness has negative effects on patients visiting KNH dental clinic

CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 INTRODUCTION
Edentulousness is defined as the condition of having no teeth.It can be classified as partial or
complete where partial edentulousness is loss of some teeth and complete is the loss of all
teeth. Tooth loss is high among adults . Astudy done showed that among the patients that
attended the prosthetic clinic during that time 58.9% of the patients were completely edentulous
and 41% were
partially edentulous. Tooth extractions are among the various treatment
procedures done in hospitals with a total of 33.4%
15
and 12.3% 13 in studies done in
Nigeria. Tooth loss can be due to a number of reasons that include dental caries ,periodontal
diseases ,traditional practices ,orthodontic treatment ,disimpactions ,prosthetic reasons and tooth
in fracture line .
Of the various causes of tooth loss,dental caries is the leading cause in all age groups and in all
teeth types except for the incisors. Dental caries is defined as a multifactorial disease that leads
to the demineralization of the tooth surface. In a number of studies done caries had the highest
prevalence with20.8% 12 56.4% 13 32.6%. Highest proportion of extraction due to caries occurred
between 21-30 years of age. More females lose their teeth due to dental caries. Most frequent
extracted teeth due to caries are the molars in particular the first permanent molars with the
Mandibular molars being mostly affected followed by the maxillary first molars. Extractions
due to caries tend to increase posteriorly.
Periodontal diseases are the second leading cause of tooth loss with the prevalence of 24.6%
and 11% in previous studies .The clinical manifestation of the periodontal disease leading to the
tooth loss includes the furcation involvement, periodontal pocket and tooth mobility .Presence of
initial attachment loss bone height and habit of smoking increase the risk of tooth
mortality.There is a strong correlation between smoking the severity of periodontal disease and
tooth mortality.More recent epidemiological data seem to suggest an increase of tooth loss due to
periodontal reasons rather than caries. A cross sectional survey reported that lower anterior teeth

were most frequently extracted due to periodontal disease followed by upper anteriors and upper
second molars. However another study showed that maxillary teeth were lost more than
mandibular teeth especially the maxillary left central incisor followed by the right central
incisor. Extractions due to periodontal disease occurred between 41-50 years and 51-60
years. Extractions of periodontal disease tend to increase anteriorly. More males lost their
teeth due to periodontal disease.
According to other studies ,there are other reasons that led to tooth loss which includes failed
rootcanal treatment which accounted for 1.5% ,orthodontic treatment needs 1.2% ,extractions of
teeth in fracture line 1.0% ,dental trauma 0.6% ,extraction of
supernumeraries 0.4% and
extractions due to prosthetics 0.2%. A great number of variables are associated with tooth loss
but there is no consensus whether dental disease related or socio-behavioural factors are most
important risk factors. Age is strongly related to every measure of tooth retention and tooth
loss 6 .The mean number of teeth lost increases with age. A study done showed that
institutionalized elderly people have in general more compromised oral health including fewer
teeth than those at the same age living freely. Race and ethnicity was consistently related to these
measures after adjustment for age and gender. Gender is also a risk factor,a study done showed
that more extractions occurred in females 62.3% and less in males37.7%. However females lost
their teeth due to caries as compared to males who lose their teeth due to periodontal
disease. Other risk factors include socio-economic status ,habits such as cigarette smoking and
caries experience.
There is a documented decline of edentulism in general .However there existsgreat differences in
prevalence between countries ,between geographical regions,within countries and between
groups with various backgrounds. There is an overall decline in the prevalence of tooth loss and
edentulism in USA over the past several decades. A trend of decreasing incidence has also been
witnessed over the last decade . However, the WHO goal of retaining at least 20 teeth at the age
of 80 years has not yet been met but is being approached in some countries.
The loss of few or all natural teeth has been accepted as a handicapping condition for the aging
elderly people. Studies on self-perception have demonstrated that tooth loss is associated with
esthetic ,functional ,psychological and social impacts for individuals. According to a study done
by Vinayak and published in 2011, 23% of the subjects had difficulty accepting tooth loss, 64%
had no difficulty accepting tooth loss, and 13% were uncertain. The time taken for acceptance of
tooth loss was also different with 35% having accepted tooth loss immediately, 53% accepted it
within 6 months, 5% within 1 year, 3% required more than 1 year, and 4% have still had not
accepted the loss. The partial dentate group were more concerned about tooth loss than complete

edentulous patients.32% of subjects talked about tooth loss with others,60% talked to their
dentists ,55% talked to their friends ,31% talked to their spouses ,and 55% talked with their
family and relatives. 25% of the subjects were not prepared for the effects of tooth loss ,70% felt
prepared ,and the rest had no answer . More than half the people who were unprepared for the
tooth loss felt that a consultation with the dentist along with education ,motivation ,and
awareness would have reduced their problems .A total of 96% did not feel any difference in their
confidence ,while the rest were indifferent .More than 50% of the subjects felt restricted with
their food choices and enjoyment of food. Position of lost teeth was associated to perceived
functional limitation.Perceived impacts were more frequent in women than men. People who
experienced difficulties in accepting their tooth loss were more likely to feel less confident
,restrict food choice ,enjoy food less ,avoid laughing in public and avoid forming close
relationships than those people with no difficulties with accepting tooth loss. This shows that
tooth loss has an effect on the oral health related quality of life.
Tooth loss can be corrected through various ways.For complete edentulous cases complete
dentures are fabricated and used to correct edentulousness .They can be implant supported or
implant retained and supported .Partial edentulousness is corrected through implants crowns
supported ,fixed bridges and removable partial dentures.The patient can also decide to have no
treatment done .Although patients usually expressed prosthodontic treatment needs ,clinical and
financial issues are determinant factors for tooth replacement. Financial limitation was
considered the most important factor that restricted access to treatment.

CHAPTER THREE
3.0 RESEARCH METHODOLOGY
3.1 STUDY SITE
This study is to be conducted in Kenyatta National Hospital dental clinic which is situtated near to
Nairobi Hospital along Upperhill road in Nairobi county.
3.2 STUDY DESIGN
This will be a descriptive cross sectional study aiming to determine the effect of loss of teeth among
patients visiting KNH dental clinic.
3.3 STUDY POPULATION
The study will be conducted among both partially and completely edentulous patients visiting
KNH dental clinic.
3.4 SAMPLING AND SAMPLE SIZE
The sample size will be computed using the following formula;
N = Z 2 P ( 1 ? P ) C 2
Where;
N=sample size

Zvalue=1.96
P=prevalence of completelyedentulous=15.6%
C=1-prevalence
Population for completely edentulous=71
Zvalue=1.96
P=prevalence of partially edentulous=54.7%
C=1- prevalence
Population for partially edentulous=46
Total population=117
3.5 DATA COLLECTION
3.5.1 PERSONNEL
A questionnaire will be used to collect data.The questionnaire will be handed to the involved
participants ,those who will have fulfilled the inclusion criteria.An investigator will administer
the questionnaire and the answers will be noted with a tick on the corresponding column of the
survey.
3.5.2 OPERATIONAL VARIABLES
a) Loss of teeth is the subject of the matter
b) indiction of sexes means female or male
3.6 INCLUSION AND EXCLUSION CRITERIA
3.6.1 INCLUSION CRITERIA
All people who are either partially or completely edentulous.
3.6.2 EXCLUSION CRITERIA
All people who are not partially or completely edentulous.

3.7 ETHICAL CONSIDERATIONS
Permission will be sought from the Kenyatta National Hospital Research Ethics and
Standard Committee. Informed consent will be obtained from all the participants who make the
inclusion criteria. Patients will be assured of confidentiality of their answers and that the use of
information will be for research purposes only.
3.8 DATA ANALYSIS
On data collection, the results will be compiled and analyzed using scientific calculator and
relevant proportion will be presented inform of tables. This will have a significance to test
hypothesis of the study.

APPENDIX I
TIME SCHEDULE
Activity Jan-Mar
2018 April 2018 May-august 2018 September 2018 Cadre
Developmen
t of the
proposal ? Supervisor/st
udent
Data
collection ? student
Data
analysis ? student
Report
writing ? student
Defense and
submission ? Supervisor/st
udent

APPENDIX II
ITEM COST
1 Data 200
2 Food 300
3 Transport 500
4 Pens 100
5 calculator 850
TOTAL 1950

QUESTIONNAIRE
CAUSES AND EFFECTS OF TOOTH LOSS AMONG PATIENTS VISITING KNH
DENTAL CLINIC.
Age(years)……….
Gender
Male……….
Female…………
KEY
? Prosthetic reason
? Orthodontic treatment
? Caries
? Trauma
? Root canal failure
FIRST QUADRANT
TOOTH 11 12 13 14 15 16 17 18
CAUSE
MISSING
SECOND QUADRANT
TOOTH 21 22 23 24 25 26 27 28
CAUSE
MISSING
THIRD QUADRANT
TOOTH 31 32 33 34 35 36 37 38
CAUSE
MISSING

FORTH QUADRANT
TOOTH 41 42 43 44 45 46 47 48
CAUSE
MISSING
EFFECTS OF TOOTH LOSS
EFFCTS OF TOOTH LOSS YES NO PREFER NOT
TO SAY
Low self esteem
Poor phonetics
Food choice
Altered facial profile
Exclusion from certain jobs(military)

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