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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 41  |  Issue : 2  |  Page : 86-91

Oral hygiene status of patients with tonsillitis and tonsilar hyperplasia in a teaching hospital


1 Department of Surgery, Benjamin Carson Snr School of Medicine, Babcock University; Dental Department, Babcock University Teaching Hospital, Ilisan-Remo, Ogun State, Nigeria
2 Department of Surgery, Ear, Nose and Throat Unit, Babcock University Teaching Hospital, Ilisan-Remo, Ogun State, Nigeria
3 Department of Surgery, Usman Dan Fodio University, Sokoto, Sokoto State, Nigeria
4 Department of Biochemistry, Babcock University, Ilisan-Remo, Ogun State, Nigeria

Date of Submission21-May-2020
Date of Decision01-Jul-2020
Date of Acceptance18-Jul-2020
Date of Web Publication02-Sep-2020

Correspondence Address:
Dr. Adekunle Moses Adetayo
Department of Surgery, Benjamin Carson Snr School of Medicine, Babcock University, Ilisan-Remo, Ogun State; Dental Unit, Babcock University Teaching Hospital, Ilisan-Remo, Ogun State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmedsci.jmedsci_145_20

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  Abstract 


Background: The number of recurrent tonsillitis and tonsillar hyperplasia requiring tonsillectomies annually is huge. Poor oral hygiene has been linked with the occurrence of these tonsillar diseases. The main objective of the present study is to determine the oral hygiene status of patients treated for tonsillitis and/or tonsillar hyperplasia at our hospital. Methods: This was a prospective case series of participants with tonsillitis or tonsillar hyperplasia at our hospital from 2018 to 2020. Results: A total of 80 participants with tonsillitis/or tonsillar hyperplasia were recruited into the study within August 2016 and March 2017 comprising 49 (61.3%) females and 31 (38.7%) males, with age ranging from 16 to 32 years (18.27 ± 4.21). Conclusions: The present study demonstrated a high proportion of less than optimal oral hygiene status in participants with tonsillitis/or tonsilar hyperplasia. This suggests that there might be an association between oral hygiene and tonsillitis/or tonsilar hyperplasia. Further research is, however, needed to prove this.

Keywords: Oral hygiene, tonsillitis, tonsillar hyperplasia


How to cite this article:
Adetayo AM, Akinola AM, Taiwo AO, Adetayo MO. Oral hygiene status of patients with tonsillitis and tonsilar hyperplasia in a teaching hospital. J Med Sci 2021;41:86-91

How to cite this URL:
Adetayo AM, Akinola AM, Taiwo AO, Adetayo MO. Oral hygiene status of patients with tonsillitis and tonsilar hyperplasia in a teaching hospital. J Med Sci [serial online] 2021 [cited 2021 Jun 21];41:86-91. Available from: https://www.jmedscindmc.com/text.asp?2021/41/2/86/294291




  Introduction Top


Tonsils and all other epithelium-lined interface surfaces of the body are exposed to the colonization by a wide range of micro-organisms.[1] In general, the establishing microbiota lives in harmony with the host because the constant renewal of the surfaces by shedding prevents the accumulation of large masses of micro-organisms.[2] In the mouth, however, teeth provide hard, nonshedding surfaces for the development of extensive bacterial deposits. This accumulation (plaque) or its calcified form, calculus, around the teeth is an indicator of poor oral hygiene and has been designated as the primary cause of caries, gingivitis, and periodontitis.[3] These oral lesions are considered as the reservoirs for the systemic spread of bacterial antigens, Gram-negative bacteria, cytokines, and other proinflammatory mediators that cause infections in other parts of the body, and especially in a contiguous structure like the tonsils.[4] This infection can occur occasionally as acute tonsillitis, or recur frequently as recurrent tonsillitis which could lead to the abnormal enlargement of the palatal tonsils referred to as tonsil hyperplasia.[5]

Studies have shown that poor oral hygiene could predispose to various diseases within and outside the oral/oropharyngeal cavity.[6] Priyadharshini et al.[7] reported a case of tonsillar actinomycosis that was possibly due to infection from actinomycosis normally found in dental plaque.[7] Similarly, Georgalas et al.[8] reported a high prevalence of poor oral hygiene with tonsillar infection while examining 158 participants in their prospective study.[8] This study was, therefore, aimed at determining the pattern of oral hygiene in patients with tonsillitis and/or tonsillar hyperplasia at our hospital.


  Methods Top


This was a prospective case series carried out at the otolaryngology clinic of Babcock University Teaching Hospital, Ilishan-Remo, Ogun State. Ethical Approval for the study was obtained from the Health Research Ethics Committee of the Babcock University (Bond University Human Research Ethics Committee 440/16, approved on 25/10/16), and written informed consent [Appendix I] was also obtained from all the participants before the inclusion in the study.

Consenting participants that were diagnosed with tonsillitis or tonsillar diseases at the otolaryngology clinic of Babcock University Teaching Hospital, within August 2016 and March 2017, were recruited into the study. Exclusion and inclusion criteria included participants with dental anomalies, systemic or immune-comprising disease, patients that have had adenotonsillectomy and those that decline consent.

A pro forma was used to collect the data that include age, gender, history of ear, nose, and throat visits, side of the affected tonsil (right/left), and also the presence/absence of indicators of tonsillitis such as tonsillar erythema, tonsillar stone, tonsillar discharge, and tonsillar tenderness/pain were documented [Appendix II].

Oral hygiene status was assessed by using oral hygiene index simplified (OHI-S) by Greene and Vermillion[9] and also with the use of decayed, missing, and filled teeth (DMFT) by the WHO.[10] Tonsil sizes were evaluated by using the Brodsky Scala Grading Scale.[11]

OHI-S simplified has two components: the Debris Index and the Calculus Index [Table 1] and [Table 2]. Six teeth representing one tooth each in the anterior and two posterior segments of both upper and lower jaws were examined for the OHI-S. The six teeth are, a central incisor in each of the anterior segment of upper and lower arches (1 + 1), and the first permanent molars in both arches (2 + 2). The buccal surfaces of the selected upper teeth and the lingual surfaces of the lower teeth were examined and allocated scores, as shown in [Figure 1]:
Table 1: Debris index

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Table 2: Calculus index

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Figure 1: Diagram showing the teeth and surfaces that were examined in oral hygiene index simplified

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Total debris score for a patient = Total of the scores for all the 6 teeth



Total calculus score for a patient = Total of the scores for all the 6 teeth





Where 6 represents the number of tooth surfaces examined:

DMFT refers to permanent teeth: D = decayed, M = Missing due to caries (not from trauma, orthodontic extraction, and congenitally missing), F = filled, T = Teeth. DMFT score for any individual can range from 0 to 32 in whole numbers.

Tonsil sizes were evaluated by using the Brodsky L. Scala[11] grading scale conceived as follows:

  • 0: Tonsils are situated in the tonsillar fossa, with no impingement on the oropharyngeal airway
  • +1: Tonsils sit just outside of the tonsillar fossa with the obstruction of <2% of the oropharyngeal airway
  • +2: Tonsils are readily seen in the airway where 2%–50% of the airway is obstructed.
  • +3: Tonsils obstruct 50%–7% of the oropharyngeal airway
  • +4: Tonsils obstruct more than 7% of the oropharyngeal airway.


The resulting OHI-S was grouped into “good” 0.0–1.2, “fair” 1.3–3.0, and “poor” 3.1–6.0, as used by Bachtiar et al.,[12] whereas DMFT was further classified into “<2,” “2,” “3–6,” “7–10,” and “>10” using the WHO.[10]

Data collected were analyzed using the SPSS (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp). Descriptive analyses for the continuous variables were presented as mean and standard deviation, whereas the categorical variables were presented as frequency and percentages. The Student t-test was used to compare the difference between the mean of continuous variables. Difference between the proportions was assessed using the Chi-square test or Fisher's exact tests. The result of the analysis was presented using the tables, whereas the level of statistical significance was set at P ≤ 0.05.


  Results Top


A total of 80 participants diagnosed with tonsillitis or tonsilar disease were recruited into the study, comprising 49 (61.3%) females and 31 (38.7%) males, ratio 1.6:1 with age ranging from 15 to 36 years (18.28 ± 4.22) [Table 3].
Table 3: Age and sex distribution of subjects

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Oral hygiene index scores (OHIS) of the participants range from 0 to 4.0, a mean value of 0.67 ± 0.83, with majority, 61 (76.3%) being good, and DMFT scores range from 0 to 6 a mean value of 0.51 ± 1.19, with majority, 70 (87.5) having <2, whereas the summation of tonsillar enlargement of both sides ranges from 2 to 8, majority having Grade 1 on either side [Table 4]. There was no difference in the comparisons between the participants' ages and the OHIS (P = 0.537) or between the subject ages and tonsillar hyperplasia (P = 0.604), but there was a difference between participant ages and DMFT (P = 0.001) [Table 5],[Table 6],[Table 7]. Furthermore, there was no difference between the comparisons of sex and OHIS, sex and DMFT, and sex and tonsillar hyperplasia [Table 8],[Table 9],[Table 10].
Table 4: Pattern of oral hygiene index scores, decayed missing filled teeth and Tonsillar sizes in subjects

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Table 5: Distribution of subjects' ages and oral hygiene index scores

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Table 6: Distribution of subjects' ages and decayed missing filled teeth

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Table 7: Distribution of subjects' ages and tonsillar sizes

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Table 8: Distribution of subjects' sex and oral hygiene index scores

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Table 9: Distribution of subjects' sex and decayed missing filled teeth

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Table 10: Comparison of age group with tonsillar hyperplasia

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There were 18 (23%) participants that had erythema on either one or both tonsils. Tonsillar pus discharge, tonsillar stone, and tonsillar tenderness occurred in 5 (6.3%), 2 (2.%), and 14 (17.%) of the participants, respectively. The comparison of OHIS with the presence/absence of tonsillar discharge, an indicator of tonsillitis was statistically significant (P = 0.041) (x[2] = 23.89, df = 6). The comparison of DMFT with the indicators of tonsillitis was, however, not statistically significant (P = 0.076, x[2] = 15.57, df = 9) The comparison of both OHIS and DMFT with tonsillar hyperplasia was also not statistically significant (P > 0.05, x[2] = 11.89, df = 10) [Table 11].
Table 11: Pattern of tonsillitis among the subjects

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  Discussion Top


Tonsillectomy following tonsillitis or tonsillar hyperplasia has been said to be most frequently done in the age group of 10–19 years, and also more commonly done in females than males.[13] This study reflected this as more females within the age group of “16–20” presented with tonsillitis/tonsillar hyperplasia than males. It is, however, in contrast to a recent study by Abraham et al.[14] where more males within the age group of 1–10 years were seen. It is worthy of note that Abraham et al.[14] was a study that involved the total attendees at a hospital, unlike this study. Studies have shown that poor oral hygiene could predispose to various diseases within and outside the oral/oropharyngeal cavity.[6] In this research, one quarter of the subject had less than optimal oral hygiene status and this reflected in the comparison between the participants OHIS and the presence of tonsillar discharge. This study may be taken as similar to Georgalas et al.[8] which linked poor oral hygiene with the tonsillitis, but it is different from Eryaman et al.[15] which did not find any association between oral hygiene and tonsillitis/tonsillar enlargement. Difference in the sample population might explain the difference in the outcome of this study and that of Eryaman et al.[15] Further researches, however, still need to be done to identify the other indicators of tonsillitis and tonsillar diseases.

Similarly, the significant difference in the comparison between DMFT and ages of participants suggest that the majority of people in the young age group would have low DMFT. However, when DMFT was compared with the indicators of tonsillitis or tonsillar hyperplasia, there was no statistically significant difference (P > 0.05). This might not be unexpected because DMFT is an index that indicates past oral hygiene practices as it takes time for caries to develop. This result seems to be in agreement with the comparison made between DMFT and tonsillitis/tonsillar enlargement by Eryman et al.[15] and also with that of Kerakawauchi et al.,[16] but in disagreement with that of Zaid.[17] Again, the difference in the age groups of participants might explain the difference in the outcome of this study and Zaid.[17] Furthermore, the low DMFT scores of participants in this study might partly explains why tonsillar enlargement is low as pointed out by Kerakawauchi et al.[16] They opined that some protein-specific immunoglobulin A and immunoglobulin G spot-forming cells are increased in patients with tonsillitis. These may act against oral bacteria such as Streptococcus mutans and Streptococcus sobrinus, the causative microorganisms for caries and thus may lead to a reduced DMFT scores.[16]

In conclusion, the present study demonstrated significantly high proportion of less than optimal oral hygiene status in participants with tonsillitis/or tonsilar hyperplasia. This suggests that there might be an association between oral hygiene and tonsillitis/or tonsilar hyperplasia. Further research is, however, needed to prove this.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Appendix I: Informed consent

The title of this research work is “Effect of oral hygiene on development of tonsillitis/tonsillar hyperplasia.

The purpose of this study is to determine the relationship between poor oral hygiene and tonsillitis or tonsillar hypertrophy. It is also to determine if past dental hygiene practices evident by DMFT could be used as markers for the development of tonsillar hypertrophy or tonsillitis.

The outcome of this research will help in enlightening the society on the need to maintain a good oral hygiene and healthy dentition so as to prevent the development of tonsillar disease and its attendant economic burden.

Should you decide not to continue with the research for any reason, be rest assured that you will not in any way be penalized. You are very free to withdraw at any stage of the research if you so wish as there is no conflict of interest of whatsoever. You are however, assured that your response will be treated in utmost confidence and used only for academic and patients management

Please bear with me as there is no reward or compensation for your participation in this study. Thank you.

If you agree with these terms, please write your name and sign this consent form on the space provided below.

Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

............................................

Signatue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

......................................





 
  References Top

1.
Manas RR, Diganta MY, Kamlesh B, Chakradhar metta adenoid hypertrophy in adults: A case series. Indian J Otolaryngol Head Neck Surg 2013;65:269-74.  Back to cited text no. 1
    
2.
Clarke NG, Hirsch RS. Personal risk factors for generalized periodontitis. J Clin Periodontol 1995;22:136-45.  Back to cited text no. 2
    
3.
Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet 2005;366:1809-20.  Back to cited text no. 3
    
4.
Stuck BA, Götte K, Windfuhr JP, Genzwürker H, Schroten H, Tenenbaum T. Tonsillectomy in children. Int J Med 2008;105:852-60.  Back to cited text no. 4
    
5.
Goldberg S, Shatz A, Picard E, Wexler I, Schwartz S, Swed E, et al. Endoscopic findings in children with obstructive sleep apnea: Effects of age and hypotonia. Pediatr Pulmonol 2005;40:205-10.  Back to cited text no. 5
    
6.
Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol 1999;4:1-6.  Back to cited text no. 6
    
7.
Priyadharshini A, Subhashree A, Ganapathy H. Actinomycosis of tonsils– Incidental or Pathological?– A case report. Int J Pharm Bio Sci 2014;5:164-8.  Back to cited text no. 7
    
8.
Georgalas C, Kanagalingam J, Zainal A, Ahmed H, Singh A, Patel KS. The association between periodontal disease and peritonsillar infection: A prospective study. Otolaryngol Head Neck Surg 2002;126:91-4.  Back to cited text no. 8
    
9.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent A 1964;68:7.  Back to cited text no. 9
    
10.
WHO: Oral Health Country/Area Profile Program. World Health Organization. Oral Health Surveys. Basic Methods. 4th ed. Geneva: World Health Organization: 1997.  Back to cited text no. 10
    
11.
Brodsky L, Moore L, Stanievich JF. A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol 1987;13:149-56.  Back to cited text no. 11
    
12.
Bachtiar EW, Putri AC, Bachtiar BM. Salivary nitric oxide, simplified oral hygiene index, and salivary flow rate in smokers and nonsmokers: A cross-sectional study. F1000Res 2019;8:1744.  Back to cited text no. 12
    
13.
Mattila PS, Tahkokallio O, Tarkkanen J, Pitkäniemi J, Karvonen M, Tuomilehto J. Causes of tonsillar disease and frequency of tonsillectomy operations. Arch Otolaryngol Head Neck Surg 2001;127:37-44.  Back to cited text no. 13
    
14.
Abraham ZS, Bazilio J, Kahinga AA, Manyahi J Ntunaguzi D, Massawe ER. Prevalence and bacteriology of tonsillitis among patients attending otorhinolaryngology department at muhimbili national hospital, Dar Es Salaam-Tanzania. Med J Zambia 2019;46:33-40.  Back to cited text no. 14
    
15.
Eryaman E, Oter B, Aydin E. Any relationship between oral hygiene and tonsillar hypertrophy? KBB-Forum 2013;12:6-9.  Back to cited text no. 15
    
16.
Kerakawauchi H, Kurono Y, Mogi G. Immune responses against Streptococcus pyogenes in human palatine tonsils. Laryngoscope 1997;107:634-9.  Back to cited text no. 16
    
17.
Zaid SH. The relationship between severity of dental caries and chronic tonsillitis among Iraqi children. J Fac Med Baghdad 2016;58:2.  Back to cited text no. 17
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11]



 

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