Chief complaints of dental patients presenting at a secondary healthcare facility in Southern Nigeria: a five-year retrospective study.

Osadolor AJ1*, Ekariama A1, Oyibo AI1, Osadolor OO2, Omorodion GI3
1Department of Dentistry, Central Hospital Oleh, Delta State, Nigeria.
2Department of Child Dental Health, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria.
3Dental Centre, Central Hospital Benin, Benin City, Edo State, Nigeria.
*Correspondence: Dr. Osadolor AJ; +234 701 391 9301; aise.osadolor@outlook.com

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Abstract

Background: Oral health is an invaluable tool in the attainment of good general health.  A chief complaint during history taking can play a role in treatment planning. Clinical, research and administrative objectives of dental practices rely on the presence of an easily identifiable and clear chief complaint.
Objective: To determine the chief complaint of dental patients presenting at a secondary healthcare facility in Southern-Nigeria.
Materials and Method:  A 5-year retrospective study was conducted at the dental department, Central Hospital, Oleh, Delta State. Variables of interest which included age, gender, occupation, religion, chief complaint, chief diagnosis and return visit were collected from the case records. The obtained data were subjected to descriptive statistics in the form of frequencies, cross-tabulations, and percentages using IBM® SPSS® Statistics version 25 software.
Results: A total of 857 cases (477 (55.7%) females and 380 (44.3%) males) containing the variables of interest were retrieved from the hospital records. The age of the patients was from 0 – 103 years with a mean age of 39.00 years. Toothache and apical periodontitis were the most common chief complaint (61.6%) and diagnosis (31.2%) among patients. Other chief complaints were broken/cracked teeth and shaking teeth. 31.2% of the patient with the complaint of toothache was diagnosed with apical periodontitis.
Conclusion: Data from this study revealed that patients of a healthcare facility in Southern Nigeria had toothache as their main chief presenting complaint and apical periodontitis as their main chief diagnosis.

Keywords: Chief complaints, Dental patients, Healthcare, Southern Nigeria.

Cite this article: Osadolor AJ, Ekariama A, Oyibo AI, Osadolor OO, Omorodion GI. Chief complaints of dental patients presenting at a secondary healthcare facility in Southern Nigeria: a five-year retrospective study. Yen Med J. 2021;3(1):25–38.

INTRODUCTION

Oral health is an invaluable tool in the attainment of good general health. Oral healthcare is becoming more tasking, due to the diagnosis and planning of treatment being dependent on the chief complaint reported by the patient.1 A chief complaint during history taking can play a role in treatment planning. Clinical, research and administrative objectives of dental practices rely on the presence of an easily identifiable and clear chief complaint.

A chief complaint is defined as a subjective statement, provided by a patient or responsible informant that describes the most significant or serious symptoms or signs of illness or dysfunction that caused him or her to seek a healthcare provider, and is generally recorded in the patient’s own words.1 Obtaining the chief complaint does not only encourage communication between the doctor and patient but also forms the framework around which a clinician builds a diagnosis.2 Multiple complaints are recorded in a chronological order to reflect the patient’s perception of the problem accurately. The severity of the chief complaint reflects the urgency of the patient to seek dental care.1

Presenting complaint of the patients is one of the most common indicators of health behaviour which will ultimately impact on oral health.3 It is the role of the dental health personnel to promote the oral health-seeking behaviour of the public, particularly through the utilisation of health services.

The chief complaints of the patients represent the demand for dental care4. It is usually recorded in the patient’s own words to know the patient’s perception of the problem.5 Previous studies 4-5 reported that the most common chief complaint that makes patients seek dental treatment was pain and pain is the main frequent complaint for which patients seek treatment.

This study was carried out due to the dearth of research data on the chief complaints of dental patients presenting at secondary healthcare facilities in Southern-Nigeria, particularly Delta State, and therefore, aims to determine the chief complaint of dental patients presenting at a secondary healthcare facility in Southern-Nigeria.

MATERIALS AND METHOD

This was a retrospective study of patients that presented at the Dental department, Central Hospital, Oleh, Delta state over five years (January 2015 – December 2019). Case records for all the patients within the study period were identified, and the variables of interest extracted from the records included age, gender, occupation, religion chief complaint, chief diagnosis and return visit. Cases with incomplete information were excluded from the study. Ethical clearance was sought and obtained from the ethical committee of the Delta State Hospitals Management Board.

Statistical analysis was carried out using the IBM® SPSS® Statistics version 25 software. For analysis, the age of the patients was categorised into childhood (0 – 17 years), adulthood (18 – 64 years) and elderly (≥ 65 years), to help highlight the clinical implications of the study. The significance tests, were the Pearson’s Chi-square and Fisher’s exact, α was set at 0.05.

 

RESULTS

A total of 857 cases containing the variables of interest were retrieved from the hospital records. The age of the patients was from 0 – 103 years with a mean age of 39.00 years; a majority of patients were adults (70.1%), 15.9% and 14.0% were children and elders respectively. Most of the patients were Christians (n = 854), 0.1% (n = 1) each were Muslims, Jehovah’s witnesses and Pagan. A total of 477 (55.7%) patients were female while 380 (44.3%) were male. Male and female patients were significantly different in their age categorisation (p < 0.002) [Table 1]. There was variety in the occupation of the patients with 17.9% being students, 14.7%, unemployed and 11.2% traders [Table 3].

Table 1: Age and sex distribution among the patients

Age category          

Male n (%)          

Female n (%)    

Total n (%)       

Children

80 (21.1)

56 (11.7)

136 (15.9)

Adults

252 (66.3)            

349 (73.2)           

601 (70.1)

Elderly                   

48 (12.6)              

72 (15.1)             

120 (14.0)

Total

380 (100)             

477 (100)             

857 (100)

χ2 = 13.89, df  = 2, p < 0.002

Toothache was the most common chief complaint (61.6%) among patients, others in descending order were broken/cracked teeth, shaking teeth and I want to clean my teeth. According to age groups, complaints of I had a road traffic accident, I have wrongly positioned teeth, and I have hole in my teeth were seen in children. Meanwhile, toothache, broken/cracked teeth and I want to clean my teeth were more commonly seen in adults. Elderly patients reported more shaking teeth, swollen jaw/face and I injured my lip/teeth. Male patients had more broken/cracked teeth, shaking teeth and I had a road traffic accident. Female patients, on the other hand, had more toothache, I want to clean my teeth and swollen gums. There was a statistically significant relationship between the chief complaint, age (p <0.001) and sex (p <0.001) [Table 2]. Across the various occupations, a majority, including the student and/or pupils’ category (n = 102), unemployed (n = 71) and traders (n = 65) had more than one-half of its respondents, with a chief complaint of toothache. Other notable chief complaint from the student and/or pupils occupation category were; I have wrongly positioned teeth (n = 9) and broken/cracked teeth (n = 13) There was a statistically significant relationship between chief complaint and occupation (p < 0.002) [Table 3].

About 31.2% of the chief diagnosis was apical periodontitis, and 17.7%, fractured teeth. Other chief diagnosis recorded were gingivitis, dentoalveolar abscess, periodontitis and pulpitis. There was a statistically significant relationship between the chief diagnosis, age (p <0.001) and sex (p = 0.008) [Table 4].  According to occupations; more than one-fourth of patients from the student and/or pupils’ category was diagnosed of apical periodontitis (n = 59), other relevant diagnosis from this occupation class included, fractured teeth (n = 24) and gingivitis (n = 11). Meanwhile, the chief diagnosis of patients from the unemployed occupation category included, apical periodontitis (n = 40), fractured teeth (n = 18) and gingivitis (n = 13). There was a statistically significant relationship between chief diagnosis and occupation (p < 0.001) [Table 5].

Toothache complaints were mainly from apical periodontitis (n = 256), fractured teeth (n = 65) and dentoalveolar abscess (n = 54). Complaints of broken/cracked teeth were mostly from patients diagnosed with fractured teeth (n = 46), shaking teeth were from fractured teeth (n = 15) and periodontitis (n = 13). Patients who complained of having a road traffic accident were either diagnosed with fractured teeth (n = 11) or mandibular or maxillary fracture/perio-endo lesion (n = 4). All patients who made the complaint ‘I want to clean my teeth’ (n = 19) were diagnosed with gingivitis. There was a statistically significant relationship between chief diagnosis and chief diagnosis (p < 0.001) [Table 6].  28% of patients made at least one subsequent dental visit after the index visit, meanwhile, 72% of patients didn’t make a return visit [Figure 1].

 

Table 2: Chief complaint distribution across age groups and sexes.

Chief Complaint                                           

Age category n (%)

Sex n (%)

Total n (%)

Children

Adults

Elderly

Male

Female

 

Toothache

59(43.4)

386(64.2)

83(69.2)

199(52.4)

329(69.0)

528(61.6)

Broken/cracked teeth

9(6.6)

42(7.0)

4(3.3)

32(8.4)

23(4.8)

55(6.5)

Shaking teeth

6(4.4)

19(3.2)

7(5.8)

19(5.0)

13(2.7)

32(3.7)

I want to clean my teeth

0(0.0)

17(2.8)

2(1.7)

8(2.1)

11(2.3)

19(2.2)

Swollen jaw/face

2(1.5)

13(2.2)

3(2.5)

8(2.1)

10(2.1)

18(2.1)

I had a road traffic accident

4(2.9)

10(1.7)

1(0.8)

10(2.6)

5(1.0)

15(1.8)

Bad breath

2(1.5)

11(1.8)

1(0.8)

10(2.6)

4(0.8)

14(1.6)

Missing teeth

0(0.0)

13(2.2)

1(0.8)

7(1.8)

7(1.5)

14(1.6)

Shocking sensation

1(0.7)

11(1.8)

0(0.0)

7(1.8)

5(1.0)

12(1.4)

I have wrongly positioned teeth

11(8.1)

1(0.2)

0(0.0)

9(2.4)

3(0.6)

12(1.4)

I have hole in my teeth

5(3.7)

5(0.8)

1(0.8)

8(2.1)

3(0.6)

11(1.3)

I injured my Lip/teeth

2(1.5)

6(1.0)

2(1.7)

7(1.8)

3(0.6)

10(1.2)

Swollen gums

4(2.9)

6(1.0)

0(0.0)

1(0.3)

9(1.9)

10(1.2)

I have extra teeth

8(5.9)

2(0.3)

0(0.0)

3(0.8)

7(1.5)

10(1.2)

Bleeding gums

3(2.2)

6(1.0)

0(0.0)

3(0.8)

6(1.3)

9(1.1)

I came for check-up

2(1.5)

6(1.0)

1(0.8)

5(1.3)

4(0.8)

9(1.1)

Broken dentures

0(0.0)

5(0.8)

3(2.5)

7(1.8)

1(0.2)

8(0.9)

I have gum/throat pain

1(0.7)

6(1.0)

1(0.8)

2(0.5)

6(1.3)

8(0.9)

I want to remove teeth

0(0.0)

7(1.2)

1(0.8)

4(1.1)

4(0.8)

8(0.9)

Facial/jaw pain

0(0.0)

4(0.7)

3(2.5)

2(0.5)

5(1.0)

7(0.8)

Unable to open/close mouth

0(0.0)

3(0.5)

3(2.5)

4(1.1)

2(0.4)

6(0.7)

My teeth is scattered

4(2.9)

1(0.2)

0(0.0)

3(0.8)

2(0.4)

5(0.6)

I want to fill teeth

0(0.0)

4(0.7)

0(0.0)

2(0.5)

2(0.4)

4(0.5)

My teeth fell off

2(1.5)

3(0.5)

0(0.0)

3(0.8)

2(0.4)

5(0.6)

My gums have ulcer

2(1.5)

0(0.0)

1(0.8)

2(0.5)

1(0.2)

3(0.4)

Teeth discolouration

0(0.0)

2(0.3)

1(0.8)

0(0.0)

3(0.6)

3(0.4)

Milk teeth refused to fall off

3(2.2)

0(0.0)

0(0.0)

2(0.5)

1(0.2)

3(0.4)

I don’t like the appearance of my teeth

2(1.5)

1(0.2)

0(0.0)

3(0.8)

0(0.0)

3(0.4)

Facial/jaw injury

0(0.0)

2(0.3)

0(0.0)

2(0.5)

0(0.0)

2(0.2)

I have a growth in my mouth

0(0.0)

2(0.3)

0(0.0)

0(0.0)

2(0.4)

2(0.2)

Gum overgrowth

2(1.5)

0(0.0)

0(0.0)

0(0.0)

2(0.4)

2(0.2)

Noticed pus in my palate

0 (0.0)

2(0.3)

0(0.0)

2(0.5)

0(0.0)

2(0.2)

Unequal face

0(0.0)

1(0.2)

0(0.0)

0(0.0)

1(0.2)

1(0.1)

Discomfort in-between teeth

1(0.7)

0(0.0)

0(0.0)

1(0.3)

0(0.0)

1(0.1)

Too much saliva inside mouth

0(0.0)

1(0.2)

0(0.0)

1(0.3)

0(0.0)

1(0.1)

Bleeding from nostrils while brushing

0 (0.0)

0(0.0)

1(0.8)

1(0.3)

0(0.0)

1(0.1)

My gum has hole

0(0.0)

1(0.2)

0(0.0)

0(0.0)

1(0.2)

1(0.1)

Discomfort in tongue

0(0.0)

1(0.2)

0(0.0)

1(0.3)

0(0.0)

1(0.1)

I injured my tongue

1(0.7)

0(0.0)

0(0.0)

1(0.3)

0(0.0)

1(0.1)

I have swelling in lower jaw

0(0.0)

1(0.2)

0(0.0)

1(0.3)

0(0.0)

1(0.1)

Total n (%)

136(100)

601(100)

120(100)

380(100)

477(100)

857(100)

                             Fisher’s exact = 172.69  p < 0.001

     Fisher’s exact = 79.59  p < 0.001

Table 3: Chief complaint distribution across occupations.

Chief complaint

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

R

S

T

U

V

Total

 

Toothache

102

71

65

55

54

51

29

22

9

9

8

8

7

7

7

7

6

2

2

2

2

3

528

 

Broken/cracked teeth

13

6

6

5

5

4

4

2

0

1

1

2

0

0

1

0

0

0

3

0

0

2

55

 

Shaking teeth

6

5

3

6

3

2

1

1

1

0

0

1

0

1

1

0

1

0

0

0

0

0

32

 

Swollen JFG

7

3

3

2

4

4

1

1

2

0

0

0

0

0

0

0

0

0

1

0

0

0

28

 

I want to clean MT

5

2

3

2

1

2

1

0

0

0

0

0

0

1

1

0

0

1

0

0

0

0

19

 

I had an RTA

4

5

2

0

0

1

1

0

0

1

0

1

0

0

0

0

0

0

0

0

0

0

15

 

Missing teeth

0

3

3

1

3

1

0

0

0

0

1

0

0

1

0

0

0

1

0

0

0

0

14

 

Bad breath

5

0

1

1

2

2

1

1

0

0

0

0

0

0

1

0

0

0

0

0

0

0

14

 

Shocking sensation

3

2

2

1

0

1

1

1

0

0

0

0

0

0

0

0

0

1

0

0

0

0

12

 

I have wrongly PT

9

2

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

12

 

I have hole in MT

7

0

2

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

11

 

I have extra teeth

6

4

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

10

 

I injured my L/T

1

2

0

0

2

1

1

1

0

1

0

0

0

0

0

0

0

0

0

0

0

0

9

 

Bleeding gums

1

4

1

1

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

9

 

Broken dentures

1

1

1

1

2

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

8

 

I want to remove teeth

2

0

1

1

2

0

0

0

1

0

0

0

0

1

0

0

0

0

0

0

0

0

8

 

I came for check-up

0

2

0

2

0

3

0

1

0

0

0

0

0

0

0

1

0

0

0

0

0

0

7

 

I have gum pain

1

2

1

0

0

1

0

0

0

0

1

0

0

0

0

1

0

0

0

0

0

0

7

 

Facial/jaw pain

1

1

0

1

1

2

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

7

 

Unable to O/C mouth

0

0

1

0

0

2

0

0

0

1

0

1

0

1

0

0

0

0

0

0

0

0

6

 

MT fell off

3

1

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

5

 

My teeth is scattered

3

1

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

5

 

I want to fill teeth

1

0

0

1

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

4

 

Milk teeth RTFO

1

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

3

 

Teeth discolouration

0

0

0

0

1

0

0

1

0

0

0

0

0

0

0

0

0

1

0

0

0

0

3

 

I don’t like the AMT

1

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

3

 

My gums have ulcer

1

1

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

3

 

Facial/jaw injury

0

0

0

0

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

Noticed pus in MP

0

0

0

1

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

Gum overgrowth

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

1

 

I have a growth IMM

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

2

 

I injured my tongue

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

I have throat pain

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

My gum has hole

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Lower jaw swelling

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 

Too much saliva IM

0

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Discomfort I/B teeth

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Unequal face

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Bleeding from NWB

0

1

0

0

0

0

0

 

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 

Discomfort in tongue

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

1

 

I injured ML with MT

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Total

186

126

96

84

84

82

42

32

13

14

12

13

7

14

11

10

7

7

6

3

3

5

857

 

Fisher’s exact = 3822.34   p = 0.180

*IM: Inside mouth; ML: My lip; L/T: Lips/Teeth; JFG: Jaw, Face and Gums; PT: Positioned teeth; RTA: Road traffic accident; MT: My teeth; AMT: Appearance of my teeth; O/C: Open/Close; NWB: Nostrils while Brushing; MP: My palate; IMM: In my mouth; RTFO: Refused to fall off; I/B: In- Between; A: Student/Pupils; B: Unemployed; C: Traders; D: Civil servants; E: Farmers; F: Business men/women; G: Teachers; H: Pensioners; I: Hair-dressers; J: Artisans; K: Tailors; L: Clergy; M: Lawyers; N: Drivers; O: Engineers; P: Corper/Bankers; Q: Nurses/Security-men/women; R: Apprentice/Healthcare worker/Caterers; S: Cobbler/Computer analyst/Cleaners; T: SSS Officer/Fisherman/Painters; U: Radiographer/IT-consultant/Lecturers; V: Military Officer/Sailor/Motor-cycle riders/Mechanic/Interior designers.

Table 4: Chief diagnosis distribution across age groups and sexes.

 

Age category n (%)

Sex n (%)

Total n (%)

Chief diagnosis                                              

Children

Male

Female

Male

Adults

 

Apical periodontitis

27(19.9)

207(34.4)

33(27.5)

99(26.1)

168(35.2)

267(31.2)

Fractured teeth

22(16.2)

107(17.8)

23(19.2)

81(21.3)

71(14.9)

152(17.7)

Gingivitis

5(3.7)

56(9.3)

20(16.7)

34(8.9)

47(9.9)

81(9.5)

Dentoalveolar abscess

12(8.8)

41(6.8)

13(10.8)

21(5.5)

45(9.4)

66(7.7)

Periodontitis

0(0.0)

35(5.8)

16(13.3)

29(7.6)

22(4.6)

51(6.0)

Pulpitis

15(11.0)

30(5.0)

0(0.0)

14(3.7)

31(6.5)

45(5.3)

Retained 10 teeth

28(20.6)

5(0.8)

0(0.0)

18(4.7)

15(3.1)

33(3.9)

Pericoronitis

3(2.2)

22(3.7)

0(0.0)

8(2.1)

17(3.6)

25(2.9)

Partial edentulism

0(0.0)

18(3.0)

5(4.2)

14(3.7)

9(1.9)

23(2.7)

Retained roots

0(0.0)

16(2.7)

1(0.8)

7(1.8)

10(2.1)

17(2.0)

Enamel hypoplasia/MIH/abrasion

0(0.0)

9(1.5)

0(0.0)

7(1.8)

2(0.4)

9(1.1)

TMJ dislocation/dysfunction syndrome

0(0.0)

5(0.8)

3(2.5)

3(0.8)

5(1.0)

8(0.9)

Mandibular/Maxillary fracture

0(0.0)

8(1.3)

0(0.0)

7(1.8)

1(0.2)

8(0.9)

Angle’s class I malocclusion cbPDRA

5(3.7)

2(0.3)

0(0.0)

4(1.1)

3(0.6)

7(0.8)

Attrition/erosion/bruxism

0(0.0)

3(0.5)

3(2.5)

3(0.8)

3(0.6)

6(0.7)

Gingival epulis/trigeminal neuralgia

1(0.7)

5(0.8)

0(0.0)

1(0.3)

5(1.0)

6(0.7)

FSI/ludwig’s angina

0(0.0)

5(0.8)

1(0.8)

3(0.8)

3(0.6)

6(0.7)

Osteosarcoma/ameloblastoma

1(0.7)

4(0.7)

0(0.0)

4(1.1)

1(0.2)

5(0.6)

Eruption gingivitis

3(2.2)

1(0.2)

0(0.0)

1(0.3)

3(0.6)

4(0.5)

Bohn’s nodule/dental caries

3(2.2)

1(0.2)

0(0.0)

4(1.1)

0(0.0)

4(0.5)

Displaced permanent tooth 20 to RPAC

2(1.5)

1(0.2)

0(0.0)

3(0.8)

0(0.0)

3(0.4)

Sialolithiasis/dentigerous cyst

0(0.0)

3(0.5)

0(0.0)

1(0.3)

2(0.4)

3(0.4)

Perio-endo lesion/failed restorations

0(0.0)

2(0.3)

1(0.8)

1(0.3)

2(0.4)

3(0.4)

Pseudo-halitosis

1(0.7)

2(0.3)

0(0.0)

2(0.5)

1(0.2)

3(0.4)

Facial nerve palsy/atypical odontalgia

0(0.0)

2(0.3)

0(0.0)

1(0.3)

1(0.2)

2(0.2)

Periodontal abscess/concussion

0(0.0)

1(0.2)

1(0.8)

0(0.0)

2(0.4)

2(0.2)

Nil 10 diagnosis: good oral condition

2(1.5)

0(0.0)

0(0.0)

1(0.3)

1(0.2)

2(0.2)

Peritonsillar/palatal abscess

0(0.0)

2(0.3)

0(0.0)

2(0.5)

0(0.0)

2(0.2)

Tongue laceration 20 to trauma

1(0.7)

1(0.2)

0(0.0)

2(0.5)

0(0.0)

2(0.2)

AHG/oral candidiasis

1(0.7)

1(0.2)

0(0.0)

0(0.0)

2(0.4)

2(0.2)

Erupting 1st molar/tooth exfoliation

2(1.5)

0(0.0)

0(0.0)

1(0.3)

1(0.2)

2(0.2)

Gingival/lip laceration

1(0.7)

1(0.2)

0(0.0)

2(0.5)

0(0.0)

2(0.2)

Atypical facial pain/dry socket

0(0.0)

2(0.3)

0(0.0)

1(0.3)

1(0.2)

2(0.2)

Dentinal hypersensitivity

0(0.0)

1(0.2)

0(0.0)

0(0.0)

1(0.2)

1(0.1)

Submandibular sialadenitis

0(0.0)

1(0.2)

0(0.0)

1(0.3)

0(0.0)

1(0.1)

Discoloured teeth

0(0.0)

1(0.2)

0(0.0)

0(0.0)

1(0.2)

1(0.1)

Ugly duckling stage of mixed dentition

1(0.7)

0(0.0)

0(0.0)

0(0.0)

1(0.2)

1(0.1)

Total n (%)

136(100)

601(100)

120(100)

380(100)

477(100)

857(100)

                                        Fisher’s exact = 264.20  p < 0.001                 Fisher’s exact = 81.21 p < 0.001

*10: Primary; 20: Secondary; TMJ: Temporomandibular Joint; FSI: Fascial space infection; MIH: Molar-incisor hypomineralisation; AHG: Acute herpetic gingivostomatitis; cbPDRA: complicated by proclined/displaced/rotated anteriors; RPAC: retained primaries/anterior crowding.

 

 Table 5: Chief diagnosis distribution across occupations.

Chief diagnosis

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

R

S

T

U

V

Total

 

Apical periodontitis

59

40

30

20

28

26

16

6

4

6

4

6

2

3

5

4

5

0

1

0

0

2

267

 

Fractured teeth

24

18

19

19

14

14

9

10

1

3

2

2

1

5

2

0

1

0

3

2

0

3

152

 

Gingivitis

11

13

11

10

9

9

2

7

0

1

0

0

0

2

3

0

0

3

0

0

0

0

81

 

Dent. Abscess

17

10

9

3

12

6

0

1

3

0

0

0

1

1

0

1

0

0

2

0

0

0

66

 

Periodontitis

2

6

7

8

7

3

4

7

1

1

0

1

0

0

1

1

1

1

0

0

0

0

51

 

Pulpitis

12

8

1

6

1

5

3

1

2

1

1

1

1

0

0

0

0

0

0

0

2

0

45

 

Retained 10 teeth

22

10

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

33

 

Pericoronitis

10

2

2

1

0

2

3

0

0

0

2

0

1

0

0

1

0

0

0

1

0

0

25

 

Partial edentulism

2

3

4

2

5

2

1

0

0

0

1

1

0

1

0

0

0

1

0

0

0

0

23

 

Retained roots

4

1

2

2

1

1

2

0

1

0

0

0

1

1

0

1

0

0

0

0

0

0

17

 

M/M fracture

3

0

1

1

1

1

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

8

 

Abrasion/erosion

1

0

2

3

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

7

 

TMJ dislocation

0

0

1

0

0

3

0

0

0

1

0

0

0

1

0

0

0

0

0

0

0

0

6

 

DH/Sial./LA

0

0

0

0

1

2

0

0

0

0

0

0

0

0

0

0

0

2

0

0

0

0

5

 

Dry socket/FSI

0

0

2

1

0

0

1

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

5

 

Bruxism/attrition

0

0

0

2

1

1

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

5

 

Gingival epulis

2

0

0

1

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

5

 

Eruption gingivitis

3

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

4

 

Dental caries/BN

2

1

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

4

 

FR/perio-endo lesion

0

1

0

1

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

3

 

P/P/P abscess

0

0

0

1

0

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

3

 

Pseudo-halitosis

1

0

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

3

 

Ameloblastoma

1

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

3

 

Angles cIcbPA

1

0

1

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

3

 

G/L laceration

0

1

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

Enamel hypoplasia

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

1

0

2

 

TMJD syndrome

0

0

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

FNP/TN

1

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

Nil 10 diagnosis

0

2

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

Angles cIcbDA

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

Ugly DSMD/TE

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

Angles cIcbRA

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

MIH/AHG

1

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

2

 

Displaced 20 TSAC

1

0

0

1

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

2

 

Tongue LST

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

2

 

Osteosarcoma

1

0

 

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

 

Atypical odontalgia

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Oral candidiasis

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Concussion

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Subm.sialadenitis

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Erupting 1st Molar

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Atypical facial pain

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Dentigerous cyst

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Displaced 20 TSRP

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Discoloured teeth

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

 

Total

186

126

96

84

84

82

42

32

13

14

12

13

7

14

11

10

7

7

6

3

3

5

857

 

                                                                     Fisher’s exact = 5603.41 p < 0.001

*Dent.: Dentoalveolar; M/M: Mandibular/Maxillary; FR: Failed restorations; LST: Laceration secondary to trauma; TSRP: Tooth secondary to retained primaries; TSAC: Tooth secondary to anterior crowding; Angles cIcbPA: Angles class I malocclusion complicated by proclined anteriors; FNP/TN: Facial nerve palsy/Trigeminal neuralgia; P/P/P: Periodontal/palatal/peritonsillar; TMJ: Temporo-mandibular joint; TMJD: Temporo-mandibular joint dysfunction; FSI: Fascial space infection; G/L: Gingival/lip; DH: Dentinal hypersensitivity; Sial.: Sialolthiasis; LA: Ludwig’s angina; MIH: Molar-incisor hypomineralisation; AHG: Acute herpetic gingivostomatitis; Angles cIcbDA: Angles class I malocclusion complicated by displaced anteriors; Sub. : Submandibular; Ugly DSMD: Ugly duckling stage of mixed dentition; TE: Tooth exfoliation; Angles cIcbRA: Angles class I malocclusion complicated by rotated anteriors; 10: Primary; 20: Secondary;

*A: Student and/or Pupils; B: Unemployed; C: Traders; D: Civil servants; E: Farmers; F: Business men/women; G: Teachers; H: Pensioners; I: Hair-dressers; J: Artisans; K: Tailors; L: Clergy; M: Lawyers; N: Drivers; O: Engineers; P: Corper/Bankers; Q: Nurses/Security-men/women; R: Apprentice/Healthcare worker/Caterers; S: Cobbler/Computer analyst/Cleaners; T: SSS Officer/Fisherman/Painters; U: Radiographer/IT-consultant/Lecturers; V: Military Officer/Sailor/Motor-cycle riders/Mechanic/Interior designers.

Figure 1: Distribution of return visits among patients.

Table 6: Chief complaint and diagnosis among patients.

 

 

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

Q

R

S

T

U

V

Total

1

256

65

54

41

30

24

18

12

1

6

0

5

0

1

0

2

0

7

3

1

0

2

528

2

0

46

1

1

1

0

0

0

0

0

0

1

0

0

0

0

0

0

1

0

0

1

55

3

1

15

0

0

13

0

0

0

0

3

0

0

0

0

0

0

0

0

0

0

0

0

32

4

0

0

0

0

0

0

0

1

0

9

0

0

0

0

0

0

0

0

0

0

0

0

10

5

0

4

1

0

0

1

0

0

0

1

0

0

0

0

0

1

0

0

0

1

0

0

9

6

0

6

0

0

0

1

0

0

0

0

0

1

0

0

0

0

0

0

1

0

0

1

10

7

1

1

8

0

0

4

0

0

0

0

2

1

3

1

1

3

3

0

0

0

0

0

28

8

2

2

1

0

1

9

0

0

0

2

0

0

0

0

0

0

0

0

0

0

0

0

17

9

0

0

0

0

0

0

0

0

0

7

0

0

1

1

0

0

0

0

0

1

2

0

12

10

0

11

0

0

0

0

0

0

4

0

0

0

0

0

0

0

0

0

0

0

0

0

15

11

0

0

0

0

0

8

1

0

0

1

0

1

3

0

0

0

0

0

0

0

0

0

14

12

5

0

0

3

0

1

1

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

11

13

0

0

0

0

0

19

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

19

14

0

0

0

0

0

0

0

0

0

3

0

0

0

1

9

1

0

0

0

0

0

0

14

15

0

0

0

0

1

5

0

0

0

0

0

0

0

0

0

0

0

1

1

0

2

7

17

16

1

0

1

0

2

1

3

0

0

0

0

0

0

0

0

0

2

0

0

0

0

0

10

17

0

0

0

0

0

0

0

0

0

0

0

0

0

0

1

1

2

0

0

0

0

0

4

18

0

0

0

0

0

1

0

0

0

3

0

0

0

1

0

0

0

1

1

1

0

0

8

19

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

0

0

0

0

0

0

13

14

20

0

0

0

0

1

1

1

0

0

0

0

0

0

0

0

0

0

0

0

1

1

0

5

21

0

0

0

0

0

0

0

0

0

0

0

1

0

0

0

0

0

0

0

0

0

1

2

22

1

2

0

0

0

3

1

1

0

0

0

0

0

0

0

0

0

1

3

0

0

0

12

23

0

0

0

0

0

2

0

0

2

0

1

0

0

0

0

0

0

0

0

0

0

0

5

24

0

0

0

0

2

0

0

0

2

0

0

0

0

0

0

0

0

0

1

0

1

0

6

Total

267

152

66

45

51

81

25

17

9

35

3

10

7

6

11

8

7

10

11

5

6

25

857

Fisher’s exact = 7892.10 p < 0.001

* 1: Toothache; 2: Broken/Cracked teeth; 3: Shaking teeth; 4: I have extra teeth; 5: My gums have ulcer/My teeth fell off/I injured my lips with my teeth; 6: Discomfort in tongue/I injured my Lip/teeth; 7: Swollen Jaw/Face/Gums; 8: I want to remove teeth/Bleeding gums; 9: I have wrongly positioned teeth; 10: I had a road traffic accident; 11: Bad breath; 12: I have hole in my teeth; 13: I want to clean my teeth; 14: My teeth is scattered/I don’t like the appearance of my teeth/Unable to open/close mouth; 15: Broken dentures/I came for check-up; 16:I have gum pain/Bleeding from nostrils while brushing/Noticed pus in my palate; 17: Unequal face/Facial pain/I have a growth in my mouth; 18: Milk teeth refused to fall off/Discomfort in-between teeth/I want to fill teeth; 19: Missing teeth; 20: Gum overgrowth/Too much saliva inside mouth/Swelling under lower jaw/My gum has hole; 21: I have throat pain/I injured my tongue; 23: Facial/Jaw injury/Discoloured teeth; 24: Jaw pain

*A: Apical periodontitis; B: Fractured teeth; C: Dentoalveolar abscess; D: Pulpitis; E: Periodontitis; F: Gingivitis; G: Pericoronitis; H: Retained roots; I: Maxillary/Mandibular fracture and Perio-endo lesion; J: Retained 10 teeth/failed restorations; K: Osteosarcoma/Discoloured teeth; L: Attrition/Eruption gingivitis/Tongue laceration 20 to trauma; M: Displaced 20 teeth  secondary to retained primaries/Ameloblastoma/Pseudo-halitosis; N: Displaced 20 teeth secondary to anterior crowding/Bohn’s nodule/Dental caries; O: Acute herpetic gingivostomatitis/Ugly duckling stage of mixed dentition/Angles class I malocclusion complicated by proclined anteriors/TMJ dislocation; P: Gingival epulis/Bruxism/Trigeminal neuralgia/Dentigerous cyst; Q: Peritonsillar abscess/Facial nerve palsy/Ludwig’s angina/Sialolithiasis/Palatal abscess; R: Periodontal abscess/TMJ dysfunction syndrome/Fascial space infection/Erosion/Enamel hypoplasia; S: Lip and/or gingival laceration/Atypical facial pain/Dry socket/Abrasion/Dentinal sensitivity; T: Molar-incisor hypomineralisation/Erupting 1st molar/Angles class I malocclusion complicated by rotated anteriors/Tooth exfoliation; U: Submandibular sialadenitis/Angles class I malocclusion complicated by displaced anteriors/Nil 10 diagnosis: good oral condition/Concussion; V: Oral candidiasis/Partial edentulism/Atypical odontalgia.

 DISCUSSION

There was a higher distribution of adults in the present study, this was in agreement with previous studies.4-5 In this study, more females than males sought dental healthcare services, a finding that correlates with some previous studies1,5-8 on oral health-seeking behaviour. However, these findings are in contrast to those from Northern Nigeria, where males rather than females dominate the dental attendance and receipt of dental treatment.9-10 There existed an array of chief complaints and diagnoses among the studied patients which may be related to the diversity in their ages, sexes, and occupations. The most acceptable explanation for the predominant oral diseases (apical periodontitis, fractured teeth, gingivitis, dentoalveolar abscess, periodontitis and pulpitis) diagnosed may be due to ignorance, low oral health awareness and knowledge,11 negative oral health attitude, cariogenic dietary pattern, dietary habits, inappropriate/adventurous lifestyle and suboptimal oral health practices. The observation of toothache as the chief complaint of patients who thought it is necessary to visit the dentist at Central Hospital, Oleh corresponds with reports from other studies that cited pain as the most common reason for patients seeking dental healthcare services.4-5,11,12 The complaint of toothache was from apical periodontitis, fractured teeth, dentoalveolar abscess, pulpitis, periodontitis, gingivitis, pericoronitis and retained roots. Toothache and apical periodontitis were higher in adults and among females. Broken/cracked teeth was the second most common complaint and was commoner among adults and males, which may be attributed to the use of motorcycles by adults in the studied community and the adventurous lifestyle of males. Apical periodontitis was the most common diagnosis, it was commoner among adults which may be due to ignorance, poor oral awareness and poverty. It was also more common among females8,13, which may be attributed to their preference for sweet diets. Fractured teeth were commoner among adults, a justified finding that can be ascribed to the prevailing use of motorcycles across sexes without adequate safety measures in the studied community. The frequency of dentoalveolar abscess among the studied population is a call for urgency as it poses a great threat of progression into more complicating infections (e.g. Ludwig’s angina and Fascial space infection) that are associated with increased risk of mortality. Other significant complaints such as I want to clean my teeth and I had a road traffic accident were commoner in adults and females, which may be due to better aesthetic considerations among females, commuting without safety practices in place. bad breath was commoner in males and was predominantly due to gingivitis which was in agreement with a previous study.6

The low percentage of patients who presented on account of dental check-up and of patients that made a subsequent return visit after the index visit reflects the poor preventive dental attendance pattern among Nigerians. This is in agreement with previous studies carried out in Nigeria.14-15 Symptomatic and irregular dental visits have been reported to be more common than preventive dental visits among Nigerians.6 This may be due to ignorance, poor oral health awareness, and poverty. The findings of this study may have been limited by its retrospective nature and the number of cases excluded because of incomplete information of interest.

CONCLUSION

Data from this study revealed that patients of a healthcare facility in Southern Nigeria had toothache as their main chief presenting complaint and apical periodontitis as their main chief diagnosis. There is a need to mobilise a community health approach in preventing the major oral diseases seen in this study.

FINANCIAL SUPPORT AND SPONSORSHIP

None.

 

CONFLICTS OF INTEREST

There are no conflicts of interest.

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