Is parity a cause of tooth loss? Perceptions of northern Nigerian Hausa women

Autoři: Elizabeth O. Oziegbe aff001;  Lynne A. Schepartz aff002
Působiště autorů: Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria aff001;  Human Variation and Identification Research Unit (HVIRU), School of Anatomical Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa aff002;  University of Pennsylvania Museum of Archaeology and Anthropology, Philadelphia, Pennsylvania, United States of America aff003
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226158



Reproduction affects the general health of women, especially when parity is high. The relationship between parity and oral health is not as clear, although it is a widespread customary belief that pregnancy results in tooth loss. Parity has been associated with tooth loss in some populations, but not in others. It is important to understand the perceptions of women regarding the association between parity and tooth loss as these beliefs may influence health behaviors during the reproductive years.


To explore the views of Hausa women regarding the link between parity and tooth loss.


Qualitative data were collected through a grounded theory approach with focus group discussions (FGDs) of high and low parity Hausa women (n = 33) in northern Nigeria. Responses were elicited on the causes of tooth loss, effects of tooth loss on women’s quality of life, issues of parity and tooth loss, and cultural beliefs about parity and tooth loss. The data were analyzed thematically using ATLAS-ti.


Respondents associated tooth loss with vomiting during labor, a condition termed ‘payar baka’. Poor oral hygiene, excessive consumption of refined carbohydrates, tooth worm, cancer and ageing were also believed to cause tooth loss. The greatest impacts of tooth loss on the lives of the respondents were esthetic and masticatory changes.


Respondents perceived that parity is indirectly linked to tooth loss, as reflected in their views on the association between vomiting during labor and tooth loss.

Klíčová slova:

Caries – Eating – Mouth – Nigeria – Oral health – Pregnancy – Teeth – Vomiting


1. Christensen K, Gaist D, Jeune B, Vaupel JW. A tooth per child? The Lancet 1998; 352: 204. doi: 10.1016/S0140-6736(05)77810-7 9683217

2. Jasienska G, Bribiescas RG, Furberg AS, Helle S, Núñez-de la Mora A. Human reproduction and health: an evolutionary perspective. The Lancet 2017; 390(10093):510–520. doi: 10.1016/S0140-6736(17)30573 28792413

3. Winikoff B, Castle MA. The maternal depletion syndrome: clinical diagnosis or eco-demographic conditions? Presented at the 1987 International Conference on Better Health for Women and Children Through Family Planning. Nairobi, Kenya; 1987.

4. Walker AR, Dison E, Walker BF. Dental caries in South African rural Black women who had large families and long lactations. J Trop Med Hyg 1983; 86(6):201–205. 6672228

5. Cruikshak DP, Hays PM. Maternal physiology in pregnancy. In: Gabbe SC, Niebyl JR, Simpson JL, editors. Obstetrics: normal and problem pregnancies. New York: Churchill Livingstone; 1991. p. 125–146.

6. Steinberg BJ. Women’s oral health issues. J Dent Educ 1999; 63(3):271–275. 10225022

7. Rundgren A, Osterberg T. Dental health and parity in three 70-year-old cohorts. Comm Dent Oral Epi 1987; 15(3):134–136. doi: 10.1111/j.1600-0528.1987.tb00500.x 3474097

8. Halling A, Bengtsson C. The number of children, use of oral contraceptives and menopausal status in relation to the number of remaining teeth and the periodontal bone height. A population study of women in Gothenburg, Sweden. Comm Dent Health 1989; 6(1):39–45. 2720476

9. Russell SL, Ickovics JR, Yaffe RA. Exploring potential pathways between parity and tooth loss among American women. Am J Public Health 2008; 98(7):1263–1270. doi: 10.2105/AJPH.2007.124735 18511717

10. Müller F, Naharro M, Carlsson GE. What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe? Clin Oral Implants Res 2007; 18(S3):2–14. doi: 10.1111/j.1600-0501.2007.01459.x 17594365

11. Saintrain MVDL, de Souza EHA. Impact of tooth loss on the quality of life. Gerodont 2012; 29(2):e632–e636. doi: 10.1111/j.1741-2358.2011.00535.x 21883422

12. Koyama S, Aida J, Saito M, Kondo N, Sato Y, Matsuyama Y, et al. Community social capital and tooth loss in Japanese older people: a longitudinal cohort study. BMJ Open 2016; 6(4):102–108. doi: 10.1136/bmjopen-2015-010768 27048636

13. Fiske J, Davis DM, Frances C, Gelbier S. The emotional effects of tooth loss. The Proc Eur Prosthodont Assoc 1997; 21: 24 (abs).

14. Fiske J, Davis DM, Frances C, Gelbier S. The emotional effects of tooth loss in edentulous people. BDJ 1998; 184(2):90–93. doi: 10.1038/sj.bdj.4809551 9489217

15. Davis DM, Fiske J, Scott B, Radford DR. Prosthetics: the emotional effects of tooth loss: a preliminary quantitative study. Br Dent J 2000; 188(9):503–506. doi: 10.1038/sj.bdj.4800522 10859849

16. Odusanya SA. Tooth loss among Nigerians: causes and pattern of mortality. Int J Oral Maxillofac Surg 1987; 16(2):184–189. doi: 10.1016/s0901-5027(87)80128-5 3110317

17. Friedling LJ, Morris AG. Pulling teeth for fashion: dental modification in modern day Cape Town, South Africa. South Afri Dent J 2007; 62(3):106–113. 17612385

18. McCaul LK, Jenkins WM, Kay EJ. The reasons for the extraction of various tooth types in Scotland: a 15-year follow up. J Dent 2001; 29(6):401–407. doi: 10.1016/s0300-5712(01)00036-7 11520588

19. Sanya B, Nganga PM, Nganga RN. Causes and patterns of missing teeth among Kenyans. E Afr Med J 2004; 81(6):322–325. doi: 10.4314/eamj.v81i6.9183 16167681

20. Esan TA, Olusile AO, Ojo MA, Udoye CI, Oziegbe EO, Olasoji HO. Tooth loss among Nigerians treated in teaching hospitals: a national pilot study. J Contemp Dent Pract 2010; 11(5):17–24. 20978720

21. Reddy NS, Reddy NA, Narendra R, Reddy SD. Epidemiological survey on edentulousness. J Contemp Dent Pract 2012; 13(4):562–570. doi: 10.5005/jp-journals-10024-1187 23151711

22. Machtei EE, Hausmann E, Dunford R, Grossi S, Ho A, Davis G. et al. Longitudinal study of predictive factors for periodontal disease and tooth loss. J Clin Periodontol 1999; 26(6):374–380. doi: 10.1034/j.1600-051x.1999.260607.x 10382577

23. Baelum V, van Palenstein Helderman W, Hugoson A, Yee R, Fejerskov O. A global perspective on changes in the burden of caries and periodontitis: Implications for dentistry. J Oral Rehabil 2007; 34:872–906. doi: 10.1111/j.1365-2842.2007.01799.x 18034671

24. Cunha-Cruz J, Hujoel PP, Nadanovsky P. Secular trends in socio-economic disparities in edentulism: USA, 1972–2001. J Dent Res 2007; 86(2):131–136. doi: 10.1177/154405910708600205 17251511

25. Celeste RK, Nadanovsky P, Fritzell J. Trends in socio-economic disparities in the utilization of dental care in Brazil and Sweden. Scand J Public Health 2011; 39(6):640–648. doi: 10.1177/1403494811414246 21730008

26. Barbato PR, Nagano HCM, Zanchet FN, Boing AF, Peres MA. Tooth loss and associated socioeconomic, demographic, and dental-care factors in Brazilian adults: an analysis of the Brazilian Oral Health Survey, 2002–2003. Cadernos de Saude Publica 2007; 23(8):1803–1814. doi: 10.1590/s0102-311x2007000800007 17653398

27. Rodriguez FR, Paganoni N, Weiger R, Walter C. Lower educational level is a risk factor for tooth loss- Analysis of a Swiss population (KREBS Project). Oral Health Prev Dent 2017; 15(2):139–145. doi: 10.3290/j.ohpd.a38097 28439581

28. Walker PL, Hewlett BS. Dental health diet and social status among Central African foragers and farmers. Amer Anthro 1990; 92(2):383–398.

29. Heidari E, Andiappan M, Banerjee A, Newton JT. The oral health of individuals with dental phobia: a multivariate analysis of the adult dental health survey, 2009. BDJ 2017; 222(8):595–604. doi: 10.1038/sj.bdj.2017.361 28428574

30. Nalçacı R, Erdemir EO, Baran I. Evaluation of the oral health status of the people aged 65 years and over living near rural district of Middle Anatolia, Turkey. Arch Gerontol Geriatr 2007; 45(1):55–64. doi: 10.1016/j.archger.2006.09.002 17097161

31. Cheng RB, Zhang Y, Cheng M, Li Y, Liu L. A sampled investigation on tooth loss of middle—aged and elders in Northeast China. Shanghai Kou Qiang Yi Xue 2009; 18(1):29–34. 19290423

32. Lukacs JR. Gender differences in oral health in South Asia: metadata imply multifactorial biological and cultural causes. Am J Hum Biol 2011a; 23(3): 398–411. doi: 10.1002/ajhb.21164 21448908

33. Lukacs JR. Sex differences in dental caries experience: clinical evidence and complex etiology. Clin Oral Investig 2011b; 15(5):649–656. doi: 10.1007/s00784-010-0445-3 20652339

34. Suominen-Taipale AL, Alanen P, Helenius H, Nord-blad A, Uutla A. Edentulism among Finnish adults of working age 1978–1997. Community Dent Oral Epi 1999; 27(5):353–365. doi: 10.1111/j.1600-0528.1999.tb02032.x 10503796

35. Simunkovic SK, Boras VV, Panduric J, Zilic A. Oral health among institutionalized elderly in Zagreb, Croatia. Geront 2005; 22(4):238–241. doi: 10.1111/j.1741-2358.2005.00086.x 16329233

36. Scheutz F, Baelum V, Matee MI, Mwangosi I. Motherhood and dental disease. Comm Dent Health 2002; 19(2):67–72. 12146584

37. Henshaw NE, Adenubi JO. The increase in dental disease in the northern states of Nigeria and its manpower implications. J Dent 1975; 3(6):243–250. doi: 10.1016/0300-5712(75)90029-9 1059643

38. Izugbara CO, Ezeh AC. Women and high fertility in Islamic northern Nigeria. Studies in Family Planning 2010; 41(3):193–204. doi: 10.1111/j.1728-4465.2010.00243.x 21469272

39. National Population Commission (NPC) [Nigeria] and ICF Macro. Nigeria Demographic and Health Survey 2008. Abuja, Nigeria: NPC and ICF Macro. National Population Commission; 2009.

40. National Population Commission, Nigeria; 2006.

41. Patton MQ. Qualitative evaluation and research methods. Newbury Park, CA: Sage Publications; 1990.

42. Strauss A, Corbin J. Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousands Oaks, CA: Sage Publications; 1998.

43. Creswell JW, Poth CN. Qualitative inquiry and research design: Choosing among five approaches. 4th ed. Thousand Oaks CA: Sage Publications; 2017.

44. Glaser BG. Theoretical sensitivity. Advances in the methodology of grounded theory. Mill Valley, CA: Sociology Press; 1978.

45. Glaser BG. The constant comparative method of qualitative analysis. In: Glaser BG, Strauss AL, (eds). The discovery of grounded theory: Strategies for qualitative research. Chicago: Aldine; 1967. pp.101–158.

46. Strauss A, Corbin J. Basics of qualitative research: Grounded theory procedures and techniques. Newbury Park, CA: Sage Publications; 1990.

47. Charmaz K. Constructing grounded theory: A practical guide through qualitative analysis. Thousands Oaks, CA: Sage Publications; 2006.

48. Morse JM. Mixing qualitative methods. Qual Health Res 2009; 19(11):523–1524. doi: 10.1177/1049732309349360 19843962

49. Muhr T. ATLAS.ti computer aided text interpretation and theory building. User's manual. Berlin: Scientific Software Development; 1994.

50. Hammersley M. Data collection in ethnographic research. In: Research and methods in Education and the Social Sciences, block 4, part 3 of course DE304. The Open University, Milton Keynes; 1979.

51. Morelli EL, Broadbent JM, Leichter JW, Thomson WM. Pregnancy, parity and periodontal disease. Austral Dent J 2018; 63(3):270–278. doi: 10.1111/adj.12623 29770451

52. Machuca G, Khoshfeiz O, Lacalle JR, Machuca C, Bullon P. The influence of general health and socio-cultural variables on the periodontal condition of pregnant women. J Periodontol 1999; 70(7):779–785. doi: 10.1902/jop.1999.70.7.779 10440640

53. Taani DQ, Habashneh R, Hammad MM, Batieha A. The periodontal status of pregnant women and its relationship with sociodemographic and clinical variables. J Oral Rehab 2003; 30(4):440–445. doi: 10.1046/j.1365-2842.2003.01058.x 12631171

54. Piscoya M, Ximenes R, Silva G, Jamelli S, Coutinho S. Periodontitis- associated risk factors in pregnant women. Clinics 2012; 67(1):27–33. doi: 10.6061/clinics/2012(01)05 22249477

55. Mandel ID. Caries through the ages: a worm's eye view. J Dent Res 1983; 62(8):926–929. doi: 10.1177/00220345830620081601 6345619

56. Schmidt GD, Roberts LS. Foundations of Parasitology. 4th ed. St. Louis; Times Mirror/Mosby College; 1989.

57. Ruby JD, Cox CF, Akimoto N, Meada N, Momoi Y. The caries phenomenon: a timeline from witchcraft and superstition to opinions of the 1500s to today's science. Int J Dent 2010; 2010:1–10. doi: 10.1155/2010/432767 20706536

58. van Leeuwenhoek A. A letter to the royal society. Phil Trans Royal Soc London 1700; 635(265).

59. Owens J, Saeed SM. Exploring the oral health experiences of a rural population in Sudan. Inter Dent J 2008; 58(5):258–264. doi: 10.1111/j.1875-595x.2008.tb00197.x 19009992

60. Gerabek WE. The tooth-worm: historical aspects of a popular medical belief. Clin Oral Invest 1999; 3(1):1–6. doi: 10.1007/s007840050070 10522185

61. Greenwood B, Greenwood A, Bradley A. Guinea worm infection in northern Nigeria: reflections on a disease approaching eradication. Trop Med Int Health 2017; 22(5):558–566. doi: 10.1111/tmi.12855 28196301

62. Njiru H, Elchalal U, Paltiel O. Geophagy during pregnancy in Africa: a literature review. Obstet Gynecol Surv 2011; 66(7):452–459. doi: 10.1097/OGX.0b013e318232a034 21944157

63. Ivoke N, Ikpor N, Ivoke O, Ekeh F, Ezenwaji N, Odo G, Iyaji F, Onoja U, Eyo J. Geophagy as risk behaviour for gastrointestinal nematode infections among pregnant women attending antenatal clinics in a humid tropical zone of Nigeria. Afri Health Sci 2017; 17(1):24–31. doi: 10.4314/ahs.v17i1.5 29026374

64. Rakchanok N, Amporn D, Yoshida Y, Rasid H, Sakamoto J. Dental caries and gingivitis among pregnant and non—pregnant women in Chiang Mai, Thailand. Nagoya J Med Sci 2010; 72(1–2):43–50. 20229702

65. Russell SL, Ickovics JR, Yaffee A. Parity and untreated dental caries in US women. J Dent Res 2010; 89(10):1091–1096. doi: 10.1177/0022034510375282 20631092

66. Razak PA, Richard KJ, Thankachan RP, Hafiz KA, Kumar KN, Sameer KM. Geriatric oral health: a review article. J Int Oral Health 2014; 6(6):110–116. 25628498

67. Nascimento GG, Leite FR, Vestergaard P, Scheutz F, Lopez R. Does diabetes increase the risk of periodontitis? A systematic review and meta-regression analysis of longitudinal prospective studies. Acta Diabetolo 2018; 55(7):653–667. doi: 10.1007/s00592-018-1120-4 29502214

68. Nordenram G, Davidson T, Gynther G, Helgesson G, Hultin M, Jemt T, Lekholm U, Nilner K, Norlund A, Rohlin M, Sunnegårdh-Grönberg K. Qualitative studies of patients' perceptions of loss of teeth, the edentulous state and prosthetic rehabilitation: a systematic review with meta-synthesis. Acta Odont Scand 2013; 71(3–4):937–951. doi: 10.3109/00016357.2012.734421 23101439

Článek vyšel v časopise


2019 Číslo 12