Factors influencing Periodontal Condition in Adult patients. A Clinical Cross-Sectional Study

Hisham A Mously¹, Abou Bakr H Hashem², Mohammed M Toras³, Amal M Bajukhaif³, Raghad A Alghamdi³, Ghada H Naguib^4,5, Mohamed T Hamed^6,7 and Abdulrahman A Maghrabi^8*

^*Correspondence: General Dentist. Abdulrahman A Maghrabi, King Abdulaziz University, Dental Hospital, Jeddah, Saudi Arabia, Email:

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Introduction

Periodontal disease refers to infectious disease that result in severe tooth-related issues such as tooth loss or the destruction of the periodontium. Conditions where tooth hygiene is not maintained result in the formation of microorganisms that further form deep periodontal pockets. This condition is less common among individuals that put significant consideration into maintaining their oral hygiene [1].

The timely diagnosis related to different periodontal conditions is highly significant, as in certain cases the severity of infections results in irreversible complications [2]. Periodontal disease causes inflammation in the soft tissues of the teeth, destroying supporting structures.

The overall prevalence of this condition ranges from 10% – 90% among the adult population [3]. Risk factors associated with the development of the periodontal disease have been stated as; poor oral hygiene, gender difference, poor economic status, increasing age, low education level, psychological distress, smoking and use of tobacco.

Behal et al. [4] posit that the excessive use of tobacco is highly effective in causing the colonization of visible and deep periodontal pockets, that contains high levels of periodontal pathogens within them. The accumulation of pathogenic microorganisms in the oral cavity may result in dental plaque leading to periodontal conditions.

To prevent the pathology, patients are usually provided basic preventive knowledge regarding the effective maintenance of oral hygiene. It has been shown that an increase in the number of gram-negative bacteria and anaerobes within the subgingival plaque causes the development of periodontal disease [5].

The procedure of professional tooth surface cleaning and screening for cavities/gum disease is routine during a dental visit [6]. Useful information regarding the current inflammatory status of periodontal tissue is provided by the periodontal probing depth. This may even indicate the chronicity of local inflammation.

There is a significant association between gingivitis and dental plaque. The young, adult, and senior populations across the world depict the existence of disparities in the level of periodontitis [7]. These disparities are associated with different aspects of periodontal conditions, including aggressive and chronic conditions.

A study conducted by Manrikian et al. [8] surveyed to investigate the tendency of increasing periodontal indices. The results reported around 2.04% cases of periodontal probing depth (4–5 mm). The periodontal conditions can be prevented and treated through appropriate selection and implementation of certain strategies derived based on epidemiologic data.

The data regarding the periodontal status of adolescents is scarce. Gautam et al. [9] provided important knowledge regarding the prevalence of periodontal diseases among individuals, where male participants were commonly affected through deep and shallow pockets.

Besides, the prevalence of early-stage periodontal diseases was more common among children, whereas, in adults, the disease was highly severe. This determines the need of providing knowledge regarding preventive measures among individuals [10].

The prevalence of periodontitis is detected among patients with a special reference to gender. The study aims to analyse the factors that are significant in determining the prevalence of periodontal diseases among adult patients.

In addition, this study aims to analyse the prevalence of non-surgical and surgical treatment that were done for the patient who need.

Methodology

The study is based on the cross-sectional epidemiological approach to evaluate the prevalence of periodontitis based on the population gender. Before conducting this study, the ethical approval was obtained from the review board of the centre where the study took place (register number 002-13).

A total of 197 individuals were selected and stratified by random sampling based on inclusion and exclusion criteria. The inclusion of participants was based on the conditions; patients with no history of periodontal treatment in last six months, the individual should have at least twenty teeth, and should be presented with minimal periodontal disease with a minimal 1-2 interdental clinical attachment loss at the site of greatest lost. Individuals with any systemic disease (like cancer, diabetes mellitus, HIV, immunosuppressive therapy, and metabolic disease), and pregnancy/lactation were excluded from the study.

Four expert calibrated examiners were appointed for performing the clinical evaluation. Calibration of examiners is important for incorporating standard examiners in the study.

For quality purposes, the inter-rater reliability was checked using Cohen’s Kappa value. Here, Kappa was calculated to be 0.76 indicating substantial agreement which was between the range of 0.38 to 0.93 for various output measures. The interclass correlation coefficient total score recorded by all four examiners was 0.99, which is excellent.

Demographic data were collected via review of medical records and personal interview in conjunction with clinical evaluation. These data included: gender, smoking status, and parafunctional habits. their parafunctional habits were checked by the examiners by examining tooth shape and muscles.

Moreover, the subject’s periodontal status was evaluated using the following measures: Plaque Index (Turesky- Gilmore-Glickman modification of the Quigley Hein Plaque Index 1970), Gingival Index, probing depth and clinical attachment level.

Furthermore, periodontal charting was recorded clinically and radiographically for proper periodontal health diagnosis. Probing depth and clinical attachment level was measured clinically and radiographically using a standard UNC-15 periodontal probe at six sites per tooth. At each site PD, recession and CAL were calculated based on the probed distances in millimetres from gingival margin to CEJ and the base of sulcus.

The data regarding surgical and non-surgical periodontal treatment was also obtained which indicated those who were treated surgically and those that did non-surgical treatment, respectively. Pearson chi-square test was used to analyse the data using Statistical Package of Social Sciences (version 23.0).

Results

The identification regarding the prevalence of periodontal disease suggested several factors that are usually responsible for periodontal diseases among various individuals. Reasons such as poor oral hygiene and smoking are responsible for the prevalence of such disease. To provide important knowledge regarding periodontal conditions, certain background knowledge is collected to identify the causes through common habits among the selected sample. Also, the dental hygiene was checked by the examiners.

Table 1 below provides the demographic details of individuals since data was collected. As per the given information in Table 1, most of the participants included females with a frequency of 125, while 75 of them were males. Smoking habits were not common among the selected individuals, as 164 participants responded with ‘No’. Next includes maintenance of oral hygiene, among the given sample 73 individuals responded for poor oral hygiene, while 106 responded for a fair status of oral hygiene, however, only 18 provided good results. Next includes parafunctional habits that were common among minimum individuals i.e., 27, while other 170 responded for No.

Table 1: Demographic details of patients.

Table 2 provides details regarding periodontal condition that were held among both males and females. The prevalence of periodontal disease was common among males with an overall percentage of 53%. However, 47% of females supported periodontal disease with a significant p-value of 0.000, indicating a positive relationship between periodontal disease and gender differences.

Table 2: Prevalence of periodontal disease based on gender differences.

Table 3 provides details regarding the prevalence of nonsurgical periodontal treatment based on gender differences. The prevalence of non-surgical periodontal treatments was common among females with the given ratio of 71.9%, while only 28.1% of males were treated through non-surgical treatments, with a p-value of 0.024 indicating a significant relationship between them.

Table 3: Prevalence of nonsurgical periodontal treatment (NSPT) based on gender differences.

Table 4 provides results regarding the prevalence of surgical periodontal treatment among individuals, based on gender differences. However, the treatment was common among females with 59.3%. While 40.7% of males were treated through surgical treatment indicated the maximum ratio for females. The attained p-value 0.785 determines an insignificant value between them.

Table 4: Prevalence of surgical periodontal treatment (SPT) based on gender differences.

Discussion

This study aims to identify the prevalence of periodontitis with a reference to gender. The results of the present study indicated that most of the individuals, maintained fair levels of oral hygiene, however, poor oral hygiene served as one of the fundamental causes of periodontal diseases. Baiju et al. [11] provided similar results while investigating the prevalence of periodontal diseases. The oral health of the sample was examined followed by the predictors of periodontal pockets and gingival bleeding. Findings of the study indicated that the prevalence of periodontal conditions such as clinical loss of attachment, gingival bleeding and periodontal pockets were common. Lack of oral hygiene was indicated as the major predictor of the given problems.

Our study revealed that the prevalence of periodontitis in males are significantly more than females. This finding agrees with previous studies [9,12-17]. The increased prevalence could be since females are more aware about maintenance of their oral hygiene and regular professional dental care. Chylinska et al. [18] did a study on the role of gender in the active attitude toward treatment and health and they reported that women showed a more active attitude, understand, and know more about their health. They also experience more positive emotions and have stronger motivation to be engaged in their health issues. This is also supported by the result of our study in regarding to the non-surgical treatment which show a significant increasing in female than male which means they are more aware regarding the professional maintenance visits.

Cases that required surgical treatment in the current sample were limited. And this is in consonance with other studies. Gautam, et al. [9] endorsed the findings of the existing study, where surgical treatments were preferred to limited individuals since most of the sample was treated through non-surgical treatments providing successful outcomes. Our study however illustrated important information regarding the need for oral hygiene instructions since most of the patients showed poor oral hygiene maintenance.

The results of the study are significant as it provides important knowledge regarding the prevalence of periodontal diseases in relation to gender. Medical experts belonging to the given field can highly benefit from the findings of the study as it helps in providing significant knowledge. Besides, academics belonging to the given field can also have a greater advantage from the findings, as data provided in the study is highly beneficial in contributing towards important information. There were several limitations of the study, the effect of smoking status on periodontal status participants were not classified based on their smoking status as light or heavy smokers. Also, the present study involves a certain limitation in the form of time, resources, and small size. This provides a way for future researchers to study the given idea by including maximum sample size, also be adding other important variables such as the type of periodontal diseases that are most common among adults.

Conclusion

Within the limitation of this study, a positive relation appears to exist between the gender and periodontal status. Furthermore, lack of oral hygiene serves as the main cause of periodontal conditions. Non-surgical treatment for periodontal conditions is the dominant and is preferred in the most of cases, while the surgical treatment is restricted to specific conditions that need more invasive treatment.

References

1. Al Yahfoufi Z, Hadchiti W. Prevalence of periodontal pathogens in a group of participants from the middle east and north africa geographic region with minimal periodontal disease. J Int Soc Prev Community Dent 2017; 7:S30.
2. BendoraitienÄ? E, ZÅ«bienÄ? J, VasiliauskienÄ? I, et al. Periodontal status in 18-year-old Lithuanian adolescents: An epidemiological study. Medicina 2017; 53:253-258.
3. Jiang H, Su Y, Xiong X, et al. Prevalence and risk factors of periodontal disease among pre-conception Chinese women. Reproductive Health 2016; 13:141.
4. Behal R, Saima S, Jan SM. Prevalence of periodontal diseases in relation to associated risk factors/ indicators amongst patients attending a government dental hospital in Kashmir. IJCMR 2016; 3:3110-3113.
5. Al-Ghutaimel H, Riba H, Al-Kahtani S, et al. Common periodontal diseases of children and adolescents. Int J Dent 2014; 2014.
6. Dima S, Wang KJ, Chen KH, et al. Decision tree approach to the impact of parents’ oral health on dental caries experience in children: a cross-sectional study. Int J Environ Res Public Health 2018; 15:692.
7. Levin L, Margvelashvili V, Bilder L, et al. Periodontal status among adolescents in Georgia. A pathfinder study. Peer J 2013; 1:e137.
8. Manrikian ME, Markarian MM, Vardanian IF. The state of periodontal and tooth tissues after the introduction of preventive measures among the children of Tavoush region, Republic of Armenia. Georgian Med News 2012; 33-36.
9. Gautam A, Jain S. Assessment of prevalence of periodontal disease and treatment needs in the general population: A hospital based study. Galore Int J Health Sci Res 2019; 4:13-17.
10. Bansal M, Mittal N, Singh TB. Assessment of the prevalence of periodontal diseases and treatment needs: A hospital-based study. J Indian Society Periodont 2015; 19:211.
11. Baiju RMP, Peter E, Nayar BR, et al. Prevalence and predictors of early periodontal disease among adolescents. J Indian Soc Periodontol 2019; 23:356-361.
12. Kundu D, Mehta R, Rozra S. Periodontal status of a given population of West Bengal: An epidemiological study. J Indian Soc Periodontol 2011; 15:126-9.
13. Eke PI, Dye BA, Wei L, et al. Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012. J Periodontol 2015; 86:611-22.
14. Janakiram C, Mehta A, Venkitachalam R. Prevalence of periodontal disease among adults in India: A systematic review and meta-analysis. J Oral Biol Craniofac Res 2020; 10:800-806.
15. Peter KP, Mute BR, Pitale UM, et al. Prevalence of periodontal disease and characterization of its extent and severity in an adult population: an observational study. J Clin Diagn Res 2014; 8:ZC04-7.
16. Chikte U, Pontes CC, Karangwa I, et al. Periodontal disease status among adults from South Africa-prevalence and effect of smoking. Int J Environ Res Public Health 2019; 16:3662.
17. Horning GM, Hatch CL, Cohen ME. Risk indicators for periodontitis in a military treatment population. J Periodontol 1992; 63:297-302.
18. ChyliÅ?ska J, Łazarewicz M, Rzadkiewicz M, et al. The role of gender in the active attitude toward treatment and health among older patients in primary health care—self-assessed health status and sociodemographic factors as moderators. BMC Geriatr 2017; 17:1.