ABSTRACT

Introduction: The relationship between cardiovascular diseases and dental conditions has been studied. However, the awareness of hypertensive patients about dental health care is very low in Nigeria. Hence, there is a need to assess the dental service utilisation in the population.
Objective: To assess the pattern and determinants of dental service utilisation in a population of hypertensives in Nigeria
Methodology: A descriptive cross-sectional study was conducted at the cardiology outpatient clinic of University of Port Harcourt Teaching Hospital (UPTH)), Nigeria. Two hundred and thirty-six (236) consented subjects were enrolled to participate in the study. Interviewer-administered questionnaires were used to collect data on demographics, hypertension history, and dental service utilisation. The data collected was analysed on IBM SPSS 25. Descriptive statistics were carried out for the socioeconomic and dental utilisation variables. Pearson’s Chi-square was used to test for the association between utilisation of dental services variables and the significant difference in the independent variables. Binary logistic regression was used to identify the factors independently associated with dental service utilisation. Significance was inferred at a p-value of ≤0.05.
Results: The mean age of the subjects was 55±14.1 years. Most of the subjects were in the 50-59-year age group. The mean hypertension duration of the subjects was 9.56±8.3 years. The male-female ratio was 1:1.2. More of the subjects, 126(53.4%), had never visited the dentist before than the 110(46.6%) who had visited. Of those who had visited before, 55(50%) visited within the last 2 to 5 years. The commonest procedure in the last visit was for scaling and polishing 54(22.9%), followed by filling of cavities 33(14%) and tooth extraction 35(14.8%).
The bivariate assessment of the utilisation of the dental clinic (Have you visited the dental clinic before?) showed that the educational status of the subjects was the only significant factor (p=0.001).
Marital status and educational status were the factors associated with utilisation of dental services, independent of other factors, with p= 0.03, odds ratio 0.51 and p= 0.001, odds ratio 0.53, respectively.
Conclusion: This study emphasizes that socioeconomic factors are strong determinants of dental service utilisation. Higher educational status and being married, which have been well-documented to positively influence health-seeking behaviour, were also found to be strong determinants of dental services utilisation among hypertensives. It is therefore important that policies that make mass education affordable and available be put in place to enhance dental service utilisation and overall health-seeking behaviour of the entire population.

KEYWORDS

Dental service utilisation, Hypertension, Determinants, Socioeconomic

REFERENCES

1) Hypertension. Geneva: World Health Organization; 2021. Available: 

https://www.who.int/news-room/fact-sheets/detail/hypertension (accessed 2021 Feb. 20).
2) GBD 2016 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1345-422.
3) Virani S. S., A. Alonso, E. J. Benjamin, M. S. Bittencourt, C. W. Callaway, A. P. Carson, Chamberlain AM, Chang AR, C et al. Heart Disease and Stroke Statistics-2020 update: a Report from the American Heart Association. Circulation. 2020;141(9):e139–e596
4) Song J-J, Ma Z, Wang J, Chen L-X, Zhong J-C. Gender differences in hypertension. J Cardiovasc Transl Res. 2020;13(1):47–54
5) Rickson Valtellini, Aviv Ouanounou, Management of the Hypertensive Dental Patient J Can Dent Assoc 2023;89:n2 (World Health Organization. Hypertension. Fact sheets. 2021. Accessed July 25, 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension).
6) Mills KT, Bundy JD, Kelly TN, et al. Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries. Circulation. 2016; 134(6): 441-450
7) Muntner P, Carey RM, Gidding S, Jones DW, Taler SJ, Wright JT, Whelton PK. Potential US Population Impact of the 2017 ACC/AHA high blood pressure Guideline. Circulation. 2018;137(2):109–18
8) Okello S, Muhih A, Mohamed SF, Ameh S, Ochimana C, Oluwasanu AO, et al. Hypertension prevalence, awareness, treatment, and control and predicted 10-year CVD risk: a cross-sectional study of seven communities in East and West Africa (Seven CEWA) BMC Public Health. 2020; 20: 1706.
9) Olubunmi. O. Onigbinde, Afolabi Oyapero, Olugbenga. A. Adenuga-Taiwo, Modupeore. E. Sorunke. Oral Hygiene Knowledge, Practices and Dental Services Utilization Pattern of Health Professionals in Lagos LASU J of Dental Sciences lasu-jds 2021;1(1): 22-25
10) Park SY, Kim SH, Kang SH et al (2019) Improved oral hygiene care attenuates the cardiovascular risk of oral health disease: a population-based study from Korea. Eur Heart J 40(14):1138– 1145. https://doi.org/10.1093/eurheartj/ehy836
11) Kim J, Kim HJ, Jeon J, Song T-J. Association between oral health and cardiovascular outcomes in patients with hypertension: a nationwide cohort study. J Hypertens. 2022;40(2):374–81.
12) Kim N-H, Lee G-Y, Park S-K, Kim Y-J, Lee M-Y, Kim C-B. Provision of oral hygiene services as a potential method for preventing periodontal disease and control hypertension and diabetes in a community health centre in Korea. Health Soc Care Community. 2018;26(3):e378–85.
13) Shin H-S. Association between the number of teeth and hypertension in a study based on 13,561 participants. J Periodontol. 2018;89(4):397–406.
14) Del Pinto R, Pietropaoli D, Munoz-Aguilera E, et al. Periodontitis and hypertension: is the association causal?. High Blood Press Cardiovasc Prev; 2020: 27(4): 281-289,
15) Muñoz Aguilera E, Suvan J, Buti J, Czesnikiewicz-Guzik M, Barbosa Ribeiro A, Orlandi M, Guzik TJ, Hingorani AD, Nart J, D’Aiuto F. Periodontitis is associated with hypertension: a systematic review and meta-analysis. Cardiovasc Res. 2020;116(1):28–39.
16) Arowojolu MO, Oladapo O, *Opeodu OI, Nwhator SO. An Evaluation of the Possible Relationship Between Chronic Periodontitis and Hypertension. J West African College Of Surgeons 2016;VOL 6 (2):20-38
17) Wang Y, Jiang Y, Chen Y, Yu L, Zhou J, Wang N et al. Associations of oral hygiene with incident hypertension and type 2 diabetes mellitus: A population based cohort study in Southwest China. J Clin Hypertens. 2022;24:483–492.
18) Baeza M, Morales A, Cisterna C, et al. Effect of periodontal treatment in patients with periodontitis and diabetes: systematic review and meta-analysis. J Appl Oral Sci. 2020; 28: e20190248
19) Song TJ, Chang Y, Jeon J, et al. Oral health and longitudinal changes in fasting glucose levels: a nationwide cohort study. PLoS One. 2021; 16(6): e0253769.
20) Soroye MO, Sorunke ME. Gingival overgrowth and associated factors in a population of Nigerian hypertensives. World Journal of Advanced Research and Reviews, 2021, 12(03), 164–174
21) Moon M, Kang S, Kim S, Park S, Seol Y, Yoon C et al. Association between toothbrushing and cardiovascular risk factors: a crosssectional study using Korean National Health and Nutrition Examination Survey 2015–2017. BMC Oral Health (2024) 24:4 https://doi.org/10.1186/s12903-023-03775-5
22) Adeniyi AA, Sofola OO, Kalliecharan RV: An appraisal of the oral health system in Nigeria. Int Dent J. 2012, 62 (6): 292-300. 10.1111/j.1875-595X.2012.00122.x.
23) Adeyemi Oluniyi Olusile, Abiola Adetokunbo Adeniyi & Olufemi Orebanjo. Self-rated oral health status, oral health service utilization, and oral hygiene practices among adult Nigerians. BMC Oral Health 2014; volume 14, Article number: 140
24) Abiola A. Adeniyi, Afolabi Oyapero. Predisposing, enabling and need factors influencing dental service utilization among a sample of adult Nigerians. Popul. Med. 2020;2(December):44 DOI: https://doi.org/10.18332/popmed/128504
25) Ernest, M.A., *Adeyemi, M.F., Bolarinwa, O.A., Alabi K.M. Oral health seeking behaviour among patients attending outpatient clinic in University of Ilorin teaching hospital (UITH) Ilorin. Res. J. of Health Sci 2022; Vol 10(2)
26) Pascaline Magne Tambe, Sylvain Raoul Simeni Njonnou, Christian Ngongang Ouankou, Christian Deube Ngako, Fernando Kemta Lekpa, Clarisse Mapa-Tassou et al. Periodontal Diseases Knowledge, Attitudes and Practices of Patients with Hypertension: A Cross-Sectional Study in Two Hospitals in the West Region (Cameroon). Int J Dent. 2025 Jun 19;2025:1749412. doi: 10.1155/ijod/1749412
27) Fu W, Lv C, Zou L, et al. Meta-analysis on the association between the frequency of tooth brushing and diabetes mellitus risk. Diabetes Metab Res Rev. 2019; 35(5): e3141
28) Alade, Grace Onyenashia; Ayanbadejo, Patricia Omowunmi1; Umeizudike, Kehinde Adesola1; Ajuluchukwu, Janet Ngozi2. Association of Elevated C-Reactive Protein with Severe Periodontitis in Hypertensive Patients in Lagos, Nigeria: A Pilot Study. Contemporary Clinical Dentistry 9(Supp 1):p S95-S99, June 2018. | DOI: 10.4103/ccd.ccd_104_18
29) Alufohai, Olohigbe O.1,; Taiwo, Juliana O.2; Sani, Balarabe3. Oral Hygiene Status and Dental Awareness of Non – Dental Health Professionals in Aminu Kano Teaching Hospital, Kano State, Nigeria. Nigerian Journal of Basic and Clinical Sciences 16(2):p 121-126, Jul–Dec 2019. | DOI: 10.4103/njbcs.njbcs_3_19
30) Olabisi AA, Udo UA, Ehimen UG, Bashiru BO, Gbenga OO, Adeniyi AO. Prevalence of dental caries and oral hygiene status of a screened population in Port Harcourt, Rivers State, Nigeria. J Int Soc Prev Community Dent. 2015 Jan-Feb;5(1):59-63. doi: 10.4103/2231-0762.151979. PMID: 25767769; PMCID: PMC4355852.
31) Bertakis KD, Azari R, Helms LJ, Callahan EJ, Robbins JA. Gender differences in the utilization of health care services. J Fam Pract. 2000 Feb;49(2):147-52. PMID: 10718692.
32) Obilor, N. M. (2024). Gender and Health Seeking Behavior in Rural Nigeria. Unizik Journal of Gender Research, 2(1). Retrieved from https://journals.aphriapub.com/index.php/UJGR/article/view/2504
33) National Data Portal, Nigeria bureau of statistics 2025.
34) Fu, H., Li, X., Zhang, R. et al. Global burden of periodontal d iseases among the working-age population from 1990–2021: results from the Global Burden of Disease Study 2021. BMC Public Health 25, 1316 (2025). https://doi.org/10.1186/s12889-025-22566-x
35) Hashim, N.T.; Babiker, R.; Padmanabhan, V.; Ahmed, A.T.; Chaitanya, N.C.S.K.; Mohammed, R.; Priya, S.P.; Ahmed, A.; El Bahra, S.; Islam, M.S.; et al. The Global Burden of Periodontal Disease: A Narrative Review on Unveiling Socioeconomic and Health Challenges. Int. J. Environ. Res. Public Health 2025, 22, 624. https://doi.org/10.3390/ijerph22040624
36) Ikpefan DO, Erhabor P, Azodo CC (2020) Oral health awareness and care seeking behaviours among public and private dental clinics attendees. Nig J Dent Sci;3(1):9-15.
37) Olaleye A.O, Suleiman I K, Solomon S. Pattern of Dental Treatment in Patients attending the Dental centre University of Maiduguri Teaching Hospital, Maiduguri Nigeria, Bo Med J 2013 ;10(1); 12-19
38) Soroye, M. O., Aikins, E. A., Eigbobo, J. O., & Umanah, A. U. (2021). Utilization of Dental services among a selected population in a Rural Community in South-South, Nigeria. The Nigerian Health Journal, 21(1), 20-27. https://doi.org/10.60787/tnhj.v21i1.502
39) Bommireddy VS, Pachava S, Ravoori S, Sanikommu S, Talluri D, Vinnakota NR. Socio-economic Status, Needs, and Utilization of Dental Services among Rural Adults in a Primary Health Center Area in Southern India. J Int Oral Health. 2014 Nov-Dec;6(6):56-60. PMID: 25628485; PMCID: PMC4295457.
40) Abodunrin, O.R., Adebayo, E.T., Adewole, I.E. et al. Factors associated with the dental service utilization by enrollees on the Lagos State health insurance scheme, Nigeria. BMC Health Serv Res 25, 14 (2025). https://doi.org/10.1186/s12913-024-12177-4
41) Nair, Vivek & Patel, Khyati & Kalra, Dheeraj & Shetty, Vittaldas. (2017). Cultural and Socioeconomic Barriers in Utilization of Dental Services: A Cross Sectional Questionnaire Based Study. National Journal of Community Medicine. 7. 807-810.
42) Abu, Owapiriba & Prayer, & Ebieteli, Rekiyat & Rekiyat, Inaingo. (2023). Education and Health Seeking Behaviour of Informal Sector Entrepreneurs in Selected Suburban Communities of Rivers State, Nigeria. 16. 48-60.
43) Hossain, B., James, K.S. Association between poor self-reported health and unmarried status among adults: examining the hypothesis of marriage protection and marriage selection in the Indian context. BMC Public Health 22, 1797 (2022). https://doi.org/10.1186/s12889-022-14170-0