Analysis of Reasons for Extraction of Permanent Teeth in Children in Senegal: A Retrospective Study

Background: Loss of permanent teeth can have negative functional, psychological and social consequences, especially for children and adolescents with growing bone structures. Knowledge of their causes is of interest in the development of comprehensive dental public health programs. The objective of this study was to evaluate the reasons for extractions of permanent teeth in children in public oral structures in Dakar. Material and method: A retrospective descriptive study, based on consultation registers and patient records, was performed. Patients between the ages of 6 and 15 who had permanent tooth extractions between January 2014 and August 2018 were included. A questionnaire including socio-demographic data, reason for consultation, reason for extraction and extracted teeth was included allowed to collect the data. Results: A total of 321 patients aged 6 to 15 years received 375 permanent tooth extractions (1.16 teeth / child). Dental caries and its complications were the main reasons for extractions (94.7%). Conclusion: Dental caries remains a real public health problem in developing countries. Decision-makers need to focus on strategies for the prevention and management of early childhood oral conditions to avoid the extraction of permanent teeth.


Introduction
The extraction of permanent teeth should not be an insignificant act, especially in children, because of the negative repercussions on eruption phenomena, the harmony of the arches, the primary functions of chewing, swallowing, breathing and phonation.
Indeed, the first permanent molar, which is the first permanent tooth to erupt, is the keystone of the occlusion; it determines the shape of the lower part of the face and conditions the position and health of the other permanent teeth [1]. The decision to extract permanent teeth must be reasoned and integrated into a global treatment plan that often requires collaboration with other dental specialties. The analysis of the causes of permanent tooth loss is of interest to practitioners and decision-makers in order to develop control strategies to be integrated into overall dental public health programs. It is from this perspective that an indirect method based on the search for reasons for these permanent tooth losses by extraction has been developed and used in many countries. Numerous studies on the causes of permanent tooth extraction in children, adolescents and adults have been conducted in industrialized countries [2][3][4][5] and caries and periodontal disease have been the main causes of extractions. In Africa, studies are rare.
The main objective of this study was to evaluate the reasons for extractions of permanent teeth in children in public oral structures in Dakar.

Results
Among 26362 children consulted, 321 patients (1.21%) aged 6 to 15 years had received permanent tooth extractions. The number of permanent teeth extracted was 375 (1.16 teeth/child). Girls had received 55.2% of extractions. The number of permanent teeth extracted was 375 (1.16 teeth / child). Girls had received 55.2% of extractions. The 12-15 age group had benefited from 77.88% ( Table   1). The distribution of extractions by health centre was 33.64% in the CHNEAR and 31.77% in HOGGY ( Table 2). The first molars accounted for 76.94% of the extracted teeth (Table 3). Dental caries and its complications were the main reasons for extracting permanent teeth in 94.16% of cases (Table 4). Pain was the reason for consultation for 74.8% of extracted teeth (Figure 1).      [8,9] have produced similar results. This is linked to an economic situation and/or a lifestyle that is not compatible with a "preventive-conscious" approach. Difficulties in access to dental care, lack of dental facilities, lack of financial resources or lack of information and education on oral health may constitute a barrier to systematic visits or consultations as soon as the first signs of dental problems appear [10]. Dental caries and its complications were the Inter Ped Dent Open Acc J 114 most common reasons for extraction of permanent teeth. The first permanent molars were the most frequently extracted teeth. These data support the results of Shammari et al [11] who reported that dental caries was the leading cause of permanent tooth extractions in patients under 40 years of age and that the first permanent molars were the most affected teeth. Other studies [12][13][14][15][16][17] have shown that the first permanent molar was the most extracted tooth with prevalence ranging from 11.7% to 86.2%. A study by Safadi et al [18] in subjects aged 13 to 20 years showed that the prevalence of extractions of the first permanent molars was 31.3%, of which 76.5% concerned the first lower molars and that dental caries and its consequences were the main reasons for extraction.
The greater susceptibility of the first molars to extraction can be explained by several factors. Their eruption, usually around 6 years of age, is silent and usually goes unnoticed, resulting in defective brushing. They have an occlusal surface whose morphology is more favourable to the retention of soft cariogenic deposits [19].
However, given their important roles, especially in children and adolescents, their extraction should be the ultimate therapeutic choice.

Conclusion
It should be noted that dental caries and its complications are the main reasons for the extraction of permanent teeth in children.
It is important to implement a policy of promotion, prevention and early management of oral diseases in children aged 12 to 15 years in order to reduce dental loss.