|Year : 2016 | Volume
| Issue : 1 | Page : 6-11
Pain-related pediatric dental attendance in a Nigerian dental clinic
Clement Chinedu Azodo1, Philip U Ogordi2
1 Department of Periodontics, University of Benin, Benin City, Edo, Nigeria
2 Department of Preventive Dentistry, University of Benin, Benin City, Edo, Nigeria
|Date of Web Publication||16-May-2016|
Clement Chinedu Azodo
Department of Periodontics, University of Benin Teaching Hospital, Room 21, 2nd Floor, Prof. Ejide Dental Complex, P. M. B. 1111, Ugbowo, Benin City, Edo
Source of Support: None, Conflict of Interest: None
Objective: To determine the characteristics of children presenting with pain at the Pediatric Dental Clinic of a Tertiary Hospital in Nigeria.
Materials and Methods: This prospective study was conducted among consecutive patients attending the Pediatric Dental Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria. Chi-square test was used in comparing proportions, and statistical significance was set at P< 0.05.
Results: A total of 193 child dental patients aged between 2 and 16 years with a mean age of 9.00 ± 3.91 years were studied. The majority of the participants were females (61.1%) aged 6–12 years (57.5%), indigenous people (64.2%), of high socioeconomic status (69.4%), and their mother had a tertiary education (63.2%). More than three-quarters (84.5%) of the participants reported tooth-related dental pain. Participants of middle and high socioeconomic status and those whose mothers had more than primary education significantly had more tooth-related pain. The primary diagnosis was mainly dental caries and its complications. The main treatment rendered includes extraction, root canal treatment, pulpectomy, and scaling and polishing. There was a significant association between age, main diagnosis, and treatment rendered.
Conclusion: Tooth-related pain which is the predominant dental pain in this study was significantly lower in children of lower socioeconomic status and whose mothers had lower educational attainment.
Keywords: Characteristics, child dental patient, dental pain, Nigeria
|How to cite this article:|
Azodo CC, Ogordi PU. Pain-related pediatric dental attendance in a Nigerian dental clinic. J Oral Res Rev 2016;8:6-11
|How to cite this URL:|
Azodo CC, Ogordi PU. Pain-related pediatric dental attendance in a Nigerian dental clinic. J Oral Res Rev [serial online] 2016 [cited 2021 Apr 23];8:6-11. Available from: https://www.jorr.org/text.asp?2016/8/1/6/182489
| Introduction|| |
Dental pain considered as unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage, originating from teeth and its supporting structures are prevalent among children worldwide. It is the most common type of orofacial pain and one of the most frequent sources of pain in humans. It has been cited as a very potent factor that drives individuals to seek dental treatment. Dental pain has also been reported as the leading presenting complaints among child dental patients in developing countries. Nomura et al. reported a 33.7% dental pain prevalence among 12–13 years old Brazilian public school children.
In Nigeria, 8.9% of patients attending dental health care setting with pain were children aged 0–16 years. Sanu et al. reported pain as the most common presenting complaint among child dental patients at the Dental and Maxillofacial Surgery Department of Aminu Kano Teaching Hospital, Kano in Nigeria. Akaji et al. in an epidemiological study, reported pain as the reason for dental attendance in more than two-thirds of the studied Nigerian adolescents.
Several studies have documented an association between dental pain, caries experience, socioeconomic status measured by parental income, family educational attainment, and ethnicity., 4, ,, High levels of caries attack, low mother schooling level, and low family income were reported to be associated to dental pain. Dental caries was cited as the most common cause of oral pain in 8-year-old children in Sri Lanka. Vargas et al. reported that almost a third of Maryland kindergartens and third graders who had caries experienced dental pain.
Dental pain results in avoidance of certain foods, sleep disturbance, self-medication, masticatory disturbances, reduced social interaction, and learning at school among children. Studies revealed that about three-quarters (72.6–74%) of children with dental pain had their daily activities hampered by pain., These daily activities include eating, brushing teeth, sleeping, playing, and going to school. Ratnayake and Ekanayake  also reported the considerable impact of dental pain on parents of affected children.
Dental pain negatively impacts on patient cooperation during treatment and the enormity of the burden of rendering dental care in uncooperative child dental patient makes studying the characteristics of children seeking dental health care due to pain necessary in order to improve the pain care preparedness among dentists. The presence of dental pain signify the failure of preventive dental health care therefore understanding the characteristics of children seeking dental health care due to pain will help in developing success-oriented preventive dental health care approach. The characteristics of children seeking dental health care due to pain have remained unstudied despite enormous impact and burden of dental pain in children, especially in developing countries. The objective of the study was to determine the characteristics of children presenting with pain at the Pediatric Dental Clinic of University of Benin Teaching Hospital, Benin City, Nigeria.
| Materials and Methods|| |
The protocol for this study was reviewed and approval granted by the Ethics and Research Committee of the University of Benin Teaching Hospital, Benin City, Nigeria. Written informed consent was obtained from parents and guardian of the children using the Nigerian National Health Research Ethics Code model.
This prospective study was conducted among consecutive patients attending the Pediatric Dental Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria between June and November 2014.
The consenting attendees at the Pediatric Dental Clinic of the University of Benin Teaching Hospital, Benin City with pain as their main presenting complaint.
Attendees at the Pediatric Dental Clinic of the University of Benin Teaching Hospital, Benin City who did not give consent and those whose main presenting complaint were not pain were excluded from the study.
Using the Cochran  statistical formula, the minimum sample size of 125 was calculated using 8.9% pain prevalence among children attending a tertiary dental health care setting in Nigeria  but 193 children were finally recruited for this study. The convenience sampling techniques was utilized in the recruitment of the participants.
Data collection tool
An interviewer-administered questionnaire was the data collection tool. The questionnaire which was anonymous with no identifiers, elicited information on age, gender, ethnicity, socioeconomic status, accompanying person, and their relationship to the patient; the attendance time (morning or afternoon), academic calendar period (school/holiday), source of pain, principal diagnosis, and treatment. Socioeconomic status was categorized using their father or guardian's educational level as high with the attainment of the tertiary institution, middle with the attainment of secondary school, and low with the attainment of primary school or no formal education. This is a modification of socioeconomic classification previously used by Oredugba and Savage among children in Nigeria.
The obtained data were subjected to univariate and bivariate analysis using SPSS version 21.0 for Windows (SPSS Inc., Chicago, IL, USA). Chi-square test was used for comparing proportions. A 95% confidence interval was set to confirm if a relationship truly existed between variables with the level of statistical significance set at P < 0.05
| Results|| |
Demographic characteristics among the participants
A total of 193 child dental patients aged between 2 and 16 years with a mean age of 9.00 ± 3.91 years and a median age of 9 years presented to the Pediatric Dental Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria during the study period with pain as their main presenting complaint. The majority of the participants were females (61.1%) aged 6–12 years (57.5%), Edo state indigenes (64.2%), of high socioeconomic status (69.4%), and their mother had a tertiary education (63.2%) [Table 1].
Relationship between demographic characteristics and presenting complaint among the participants
More than three-quarters (84.5%) of the participants reported tooth-related pain. Ageing resulted in increased tooth-related pain and decline in gingiva-related pain, but this was not statistically significant. Participants of middle and high socioeconomic status and those whose mothers had more than primary education significantly reported more tooth-related pain while the participants of low socioeconomic status and those whose mothers had lower than secondary education reported more gingiva-related pain [Table 2].
|Table 2: Relationship between demographic characteristics and presenting complaint among the participants|
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Relationship between presenting complaint and attendance characteristics among the participants
All the patients were accompanied with most being accompanied by one adult (83.9%). Mothers constituted the majority (61.1%) of the accompany person. More than three-quarters (79.3%) of the participants attend the clinic within the morning hours, and more than two-thirds (67.4%) made it during the school calendar period [Table 3].
|Table 3: Relationship between presenting complaint and attendance characteristics and among the participants|
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Primary diagnosis and treatment in relation to age and gender among the participants
The main diagnosis was mainly acute pulpitis, chronic pulpitis, dental caries, and dentoalveolar abscess. The relationship between age and the primary diagnosis was statistically significant. Tooth extraction was the leading procedure rendered for the participants followed by endodontic treatment in the form of root canal treatment (RCT), pulpotomy and pulpectomy. The relationship between age and rendered treatment was statistically significant. Ageing resulted in increased receipt of tooth extraction [Table 4].
|Table 4: Primary diagnosis and treatment in relation to age and gender among the participants|
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| Discussion|| |
This study set to determine the characteristics of children presenting with pain at the Pediatric Dental Clinic of University of Benin Teaching Hospital, Benin City, Nigeria found that more than half of the children were 6–12 years which is the mixed dentition stage burdened with a lot of dental problems that may need or may not need professional dental care.
Female child dental patients outnumbered the male child dental patients in seeking dental care for pain. The more dental attendance because of dental pain among females than males in adult Nigerian population may be the obvious influencing factor., The cultural influence on pain perception and expression may relatively inhibit male children from reporting pain to their parents than the female children thereby explaining why more female children than male children presenting with pain for dental care.
Indigenes of the state where the studied hospital is located constituted the majority of the patients. The claim of ownership of government establishment in any location by the indigenes as stakeholders and personalizing the establishment in this regard the hospital, as their own may increase their confidence and lessen their anxiety and fear to visit the dentist with their children. Anxiety and fear have been severally reported to inhibit dental attendance worldwide.,, The ethnic variation of dental problems that invariably present with pain may also explain why more indigenes sought dental care for pain than nonindigenes.
The burden and suffering of a child are worrisome to the parents and relatives, especially with dental pain which causes avoidance of certain foods, sleep disturbance, self-medication, masticatory disturbances, reduce social interaction, and learning at school., This may explain why more than three-quarters (79.3%) of the participants attend the clinic within the morning hours, more than two-thirds (67.4%) made it during school calendar period, and one out of every six child in this study was accompanied by two adults.
A few cases in this study were accompanied by their nonparents. This shows that parental consent for dental treatment in children may not have been strictly adhered to and may lead to legal action, especially if the parents are not satisfied or comfortable with the rendered treatment.
The majority of the dental pain was tooth-related pain which may be related to increasing prevalence of dental caries in Nigeria. This is confirmatory from the cumulative proportion of the participants in this study whose primary diagnosis was dental caries and its complications (acute pulpitis, chronic pulpitis, acute apical periodontitis, and dentoalveolar abscess). Dental caries and its complications constituted 71.5% of the diagnosis in this study which was higher than 68.2% and 46.2% reported among children treated in Nigerian Teaching Hospitals. The restriction of this study to patients presenting with pain may be the explanation for the higher prevalence of dental caries and its complications in the study. Several studies found an association between dental caries and dental pain experience in children., 4, ,,
The prominence of dental caries and its complications may be linked to the predominance of the high socioeconomic status of the children and those whose mothers had more than primary education in this study that significantly had more tooth-related pain. Unlike findings in developed countries,, the higher socioeconomic status endows the parents with available income for increased sugar consumption in the midst of poor oral health practices thereby favoring dental caries which will result in tooth-related pain. The period of crawling, learning to stand, and walking in childhood is usually associated with a lot of falls explaining why 0–5 years old participants had more traumatic dental injuries (fracture, luxation, and avulsion). The large size of pulp in younger children increases the tendencies of dental caries involving the pulp leading to acute pulpitis.
Tooth extraction was the leading procedure (37.8%) rendered in this study. Although this is lower than 58.8% tooth extraction reported by Ashiwaju et al. in a Nigerian tertiary dental health care setting, it however reflects that symptomatic and delayed dental attendance results frequently in tooth extraction. About a third (32.6%) of the patients in this study received endodontic treatment in the form of pulpotomy, pulpectomy, and RCT, which was higher than 11% reported by Ajayi et al. and 2.8% reported by Sanu et al. in Southern and Northern parts of Nigeria, respectively. The prominence of endodontic treatment in this study may be connected with the high socioeconomic status of the children because their parents could afford the treatment. The treatment rendered was significantly associated with ageing as tooth extraction was found to be higher in older children. This could be explained by more complicated cases seen in older children as the 13–16 years had more diagnosis of the dentoalveolar abscess.
This study was able to determine the characteristics of children attending the studied health care setting with dental pain, but the findings may be limited by the nonassessment of the characteristics of the dental pain despite grouping it into tooth-related and gingiva-related pains.
| Conclusion|| |
Tooth-related pain, which is the predominant dental pain in this study, was significantly lower in children of lower socioeconomic status and whose mothers had lower educational attainment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Slade GD. Epidemiology of dental pain and dental caries among children and adolescents. Community Dent Health 2001;18:219-27.
Sanu OO, Oredugba FA, Adebola RA. Oral and dental diseases among children and adolescents in Kano, Nigeria. Pesqui Bras Odontopediatria Clín Integr 2010;10:445-50.
Masiga MA. Presenting chief complaints and clinical characteristics among patients attending the Department of Paediatric Dentistry Clinic at the University of Nairobi Dental Hospital. East Afr Med J 2005;82:652-5.
Nomura LH, Bastos JL, Peres MA. Dental pain prevalence and association with dental caries and socioeconomic status in schoolchildren, Southern Brazil, 2002. Braz Oral Res 2004;18:134-40.
Gbenga Omitola O, Olabisi Arigbede A. Prevalence and pattern of pain presentation among patients attending a tertiary dental center in a southern region of Nigeria. J Dent Res Dent Clin Dent Prospects 2010;4:42-6.
Akaji EA, Oredugba FA, Jeboda SO. Utilization of dental services among secondary school students in Lagos, Nigeria. Niger Dent J 2007;15:87-91.
Ratnayake N, Ekanayake L. Prevalence and impact of oral pain in 8-year-old children in Sri Lanka. Int J Paediatr Dent 2005;15:105-12.
Vargas CM, Macek MD, Goodman HS, Wagner ML. Dental pain in Maryland school children. J Public Health Dent 2005;65:3-6.
Tickle M, Blinkhorn AS, Milsom KM. The occurrence of dental pain and extractions over a 3-year period in a cohort of children aged 3-6 years. J Public Health Dent 2008;68:63-9.
Moure-Leite FR, Ramos-Jorge J, Ramos-Jorge ML, Paiva SM, Vale MP, Pordeus IA. Impact of dental pain on daily living of five-year-old Brazilian preschool children: Prevalence and associated factors. Eur Arch Paediatr Dent 2011;12:293-7.
Cochran WG. Sampling Techniques. 3rd
ed. New York: John Wiley & Sons; 1977.
Oredugba FA, Savage KO. Anthropometric finding in Nigerian children with sickle cell disease. Pediatr Dent 2002;24:321-5.
Odai ED, Ehizele AO, Enabulele JE. Assessment of pain among a group of Nigerian dental patients. BMC Res Notes 2015;8:251.
Finley GA, Kristjánsdóttir O, Forgeron PA. Cultural influences on the assessment of children's pain. Pain Res Manag 2009;14:33-7.
Pohjola V, Lahti S, Vehkalahti MM, Tolvanen M, Hausen H. Association between dental fear and dental attendance among adults in Finland. Acta Odontol Scand 2007;65:224-30.
Milgrom P, Newton JT, Boyle C, Heaton LJ, Donaldson N. The effects of dental anxiety and irregular attendance on referral for dental treatment under sedation within the National Health Service in London. Community Dent Oral Epidemiol 2010;38:453-9.
Armfield JM, Stewart JF, Spencer AJ. The vicious cycle of dental fear: Exploring the interplay between oral health, service utilization and dental fear. BMC Oral Health 2007;7:1.
Huang DL, Park M. Socioeconomic and racial/ethnic oral health disparities among US older adults: Oral health quality of life and dentition. J Public Health Dent 2015;75:85-92.
Folaranmi N, Akaji E, Onyejaka N. Pattern of presentation of oral health conditions by children at University of Nigeria Teaching Hospital, Enugu: A retrospective study. Niger J Clin Pract 2014;17:47-50.
Eigbobo JO, Onyeaso CO, Okolo NI. Pattern of presentation of oral health conditions among children at the University of Port Harcourt Teaching Hospital (UPTH), Port Harcourt, Nigeria. Pesqui Bras Odontopediatria Clín Integr 2011;11:105-9.
Reisine ST, Psoter W. Socioeconomic status and selected behavioral determinants as risk factors for dental caries. J Dent Educ 2001;65:1009-16.
Truin GJ, König KG, Bronkhorst EM, Frankenmolen F, Mulder J, van't Hof MA. Time trends in caries experience of 6- and 12-year-old children of different socioeconomic status in The Hague. Caries Res 1998;32:1-4.
Ashiwaju MO, Folayan MO, Sote EO, Isikwe MC. Pattern of tooth extraction in children attending tertiary health care centers in Nigeria: A prospective study. J Clin Pediatr Dent 2011;36:107-10.
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.
Ajayi YO, Ajayi EO, Sote EO, Olatosi OO, Orenuga OO. Pattern of endodontic treatment in children in a Nigerian tertiary hospital. Nig Q J Hosp Med 2009;19:32-6.
[Table 1], [Table 2], [Table 3], [Table 4]