Aim: To determine the current causes and pattern of tooth loss in lle-lfe Nigeria. Design: A retrospective review of records of dental extraction patients. Setting: The dental hospitals of the Obafemi Awolowo University Teaching Hospital situated in South Western Nigeria. Participants: All patients that had dental extractions between January 1996 and December 2002. Method: Patients' case records were analysed for demographics, reason(s) for dental extraction, tooth/ teeth extracted, method of extraction and complication(s). Main outcome measure: Reasons for tooth extraction and the pattern of tooth loss. Results: 6,348 (12.3%) of hospital attendees aged 4-102 years (mean 35 +/- 16.8 years) had extraction of 8,338 teeth. A statistically significant female preponderance was observed. Dental caries was the leading cause of tooth loss (56.4%) followed by periodontal disease (24.6%). This shows a reversal of a trend reported in a previous study in the same location. Over half (69.2%) of the extracted teeth were molars (mostly mandibular). Only 4.1% extractions were trans alveolar. 3.9% were complicated by dry socket. Conclusion: 12.3% of the hospital attendees had undergone dental extraction. Despite previous warnings of a steady rise in dental caries, it has become the leading cause of tooth loss in our hospital. The urgent need to institute standardised preventive Aim: To determine the current causes and pattern of tooth loss in lle-Ife Nigeria. Design: A retrospective review of records of dental extraction patients. Setting: The dental hospitals of the Obafemi Awolowo University Teaching Hospital situated in South Western Nigeria. Participants: All patients that had dental extractions between January 1996 and December 2002. Method: Patients'case records were analysed for demographics, reason(s) for dental extraction, tooth/ teeth extracted, method of extraction and complication(s). Main outcome measure: Reasons for tooth extraction and the pattern of tooth loss. Results: 6,348 (12.3%) of hospital attendees aged 4-102 years (mean 35 16.8 years) had extraction of 8,338 teeth. A statistically significant female preponderance was observed. Dental caries was the leading cause of tooth loss (56.4%) followed by periodontal disease (24.6%). This shows a reversal of a trend reported in a previous study in the same location. Over half (69.2%) of the extracted teeth were molars (mostly mandibular). Only 4.1% extractions were trans alveolar. 3.9% were complicated by dry socket. Conclusion: 12.3% of the hospital attendees had undergone dental extraction. Despite previous warnings of a steady rise in dental caries, it has become the leading cause of tooth loss in our hospital. The urgent need to institute standardised preventive measures was highlighted.measures was highlighted.