|Year : 2018 | Volume
| Issue : 4 | Page : 192-197
Assessment of periodontal status among the outpatients attending private university dental clinics in Riyadh city, Saudi Arabia
Osamah Mohammed AI Mugeiren
Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
|Date of Web Publication||28-Aug-2018|
Dr. Osamah Mohammed AI Mugeiren
Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Box: 84891, Riyadh 11681
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Aim of the Study: The study aims to evaluate the prevalence of gingivitis and periodontitis among dental outpatients attending Munisiya Clinics of Riyadh Elm University using CPI criteria and also to compare the results with age, gender, systemic condition, smoking, and the use of oral hygiene measures. Materials and Methods: The periodontal status of 214 (90 male and 124 female) patients selected from outpatient's clinics in Munisiya Campus of Riyadh Elm University was evaluated according to the Community Periodontal Index (CPI) criteria. A close-ended, self-administered questionnaire recorded the patient's personal characteristics (age, gender, systemic condition, smoking, and the use of oral hygiene measures). The study population comprised three age groups – Group I: consisted of 148 patients aged 20–34 years old, Group II: consisted of 39 patients aged 35–49 years old, and Group III: consisted of 27 patients aged 50–64 years old. Data were collected tabulated and statistically analyzed to compare between all groups. Results: Our results showed that age and smoking status were considered significant factors associated with periodontitis. Furthermore, the highest prevalence of gingivitis was among younger age groups, while the highest prevalence of periodontitis was among older age groups. Furthermore, the highest prevalence of gingivitis and periodontitis was seen among males compared to female population. Conclusions: Smoking and diabetes mellitus were strongly associated with periodontitis. Moreover, irregular oral hygiene measures were considered among the risk factors of gingivitis and periodontitis.
Keywords: Assessment, clinic, gingivitis, outpatient, periodontitis
|How to cite this article:|
AI Mugeiren OM. Assessment of periodontal status among the outpatients attending private university dental clinics in Riyadh city, Saudi Arabia. J Int Oral Health 2018;10:192-7
|How to cite this URL:|
AI Mugeiren OM. Assessment of periodontal status among the outpatients attending private university dental clinics in Riyadh city, Saudi Arabia. J Int Oral Health [serial online] 2018 [cited 2020 Feb 24];10:192-7. Available from: http://www.jioh.org/text.asp?2018/10/4/192/236953
| Introduction|| |
Periodontal epidemiology studies the variations in the occurrence of periodontal diseases, and the reasons behind these variations. Periodontal epidemiology is mainly concerned with the description of the distribution of periodontal diseases, identification of causes of the problems, and application of the information from descriptive and analytical studies to control these periodontal problems.
Current evidence suggests that gingivitis and periodontitis are inflammatory reservoirs of potential infections. Therefore, periodontal diseases are found to have an association with preterm low birth weight delivery and adverse pregnancy outcomes,, erectile dysfunction, risk for cardiovascular diseases, obesity and type 2 diabetes mellitus, metabolic syndrome,, Alzheimer's disease, and many more conditions. The mounting incidence and the prevalence of periodontal disease burden with its associated systemic conditions can pose a huge financial impact on the health-care systems. Hence, there is a need to reduce the burden of periodontal disease among the population.
The frequency and magnitude of periodontal disease problems among population must be addressed by practical preventive, diagnostic, and therapeutic measures to promote periodontal health. In addition, it is necessary to manage periodontal disease-related socioeconomic consequences by considering country-specific measures. Measuring periodontal disease among patients attending university dental clinics can give an idea of periodontal disease burden in the local community.
The community periodontal index of treatment needs (CPITN) was developed as an extension of the periodontal treatment needs system for the purpose of identifying the prevalence and severity of periodontal conditions with respect to the treatment needs in the community as well as in the individual. Use of the epidemiological part of the CPITN, now called the CPI, involves the scoring of ten index teeth representing sextants in the mouth on a nominal scale according to the presence of pathologic pockets, calculus, or gingival bleeding. The scoring is done in a hierarchical manner, and a diagnosis is made of the worst finding in sextants and in participants.
The CPITN index was developed on the belief that the gingivitis-periodontitis continuum and keeping in view of interventions that are considered necessary. In addition, perceived etiologic factor (calculus) in the scoring system has been incorporated. The use of the CPITN for periodontal epidemiological purposes based on a view that the signs and symptoms amenable to specific forms of treatment, and it can be used to indicate the extent and severity of periodontal diseases.
Riyadh Elm University through its satellite dental clinics in the eastern part of the Riyadh city serves many patients from different ages and socioeconomic statuses. Therefore, it provides an opportunity for assessing the magnitude and severity of the periodontal diseases among the patients. Hence, the present study aimed to evaluate the prevalence of gingivitis and periodontitis among outpatient's attending Munisiya Dental Clinics of Riyadh Elm University by applying the CPI criteria.
| Materials and Methods|| |
Permission to perform this research was received from the research center of Riyadh Elm University, Riyadh, Saudi Arabia. The study was approved with registration number FRP/2018/196.
Study setting and sample
The present study was conducted in Satellite Dental Clinics (Munisiya Campus) of Riyadh Elm University. A total of 214 (90 male and 124 female) patients were selected from outpatient's clinics by employing convenient sampling methodology. The study was conducted from July 2017 to January 2018. The study participants were divided into Group I: consisted of 148 patients aged 20–34 years old, Group II: consisted of 39 patients aged 35–49 years old, and Group III: consisted of 27 patients aged 50–64 years old.
A self-administered, structured, and close-ended questionnaire was used to collect the personal information (age, gender, smoking status, medical condition, and regular oral hygiene practices) of the patients.
The oral examination of the participants was conducted using standard explorers, mouth mirrors, and UNC probes, while the patient seated upright position in a dental chair under overhead light. Proper sterilization was maintained during the examination. It took on an average 5–6 min to complete the examination. A single experienced periodontist performed all the oral examinations. The intraexaminer reliability for various recordings ranged from 0.90 to 0.96.
The CPITN described by Ainamo et al. was used to examine periodontal conditions of all the patients. CPI as an indicator of periodontal status was used for this assessment. It includes the presence of gingival bleeding, supra- or subgingival calculus, and periodontal pockets, subdivided into shallow (4–5 mm) and deep (6 mm or more). A periodontal probe no. 621 WHO was used for the examination purpose. This probe has a ball end with a diameter of 0.5 mm, which allows a thorough examination of the surface of each tooth, especially the root cementum. Above the ball, there is an area corresponding to the depth of a gingival pocket of 3.5 mm, which is considered the physiological depth of a periodontal pocket. After that, there is a black field extending to the depth of 3.5–5.5 mm, which corresponds to a pathological pocket. The probing force not exceeding 25 g was applied while testing. For each tested sextant, periodontal status was determined by the following codes. Periodontal status was coded as follows: code 0 – no signs of inflammation (CPI-0); code 1 – presence of bleeding with gentle probing (CPI-1); code 2 – presence of supra- and/or subgingival calculus or overhanging fillings (CPI-2); code 3 – presence of pathological periodontal pockets of 3.5–5.5-mm depth (CPI-3); code 4 – presence of pathological periodontal pockets of 5.5 mm and deeper (CPI-4); and code X – sextants excluded from examination (less than two teeth present). In each sextant of the teeth, the highest CPI code value was evaluated. Codes 1 and 2 were considered gingivitis while scores 3 and 4 were considered for periodontitis.
Descriptive statistics of frequency distribution and percentages were calculated for the CPI codes with regard to age, gender, smoking habits, systemic condition, and regular use of oral hygiene methods. Chi-square test was applied to assess the significant difference between the variables. P < 0.05 was considered statistically significant. All the statistical analysis was performed using IBM-SPSS version 21 software, Armonk, NY, USA.
| Results|| |
A sample of 214 (male = 90 and female = 124) patients seeking dental care in Munisiya Dental Clinics participated in the study. Periodontal status of the patients was evaluated based on the CPI criteria; Code 1 and Code 2 were considered for gingivitis and Code 3 and Code 4 for periodontitis.
The study results revealed that an overall 125 (58.4%) patients were suffering with gingivitis and 50 (23.4%) having periodontitis and only 39 (18.2%) patients were healthy, respectively. Age categories showed that the prevalence of gingivitis and periodontitis among Group I (20–34 years) 61.4% and 16.9%, Group II (35–49 years) 59% and 30.7%, and Group III (50–64 years) 40.7% and 48.1%, respectively [Table 1].
|Table 1: Prevalence of gingivitis and periodontitis among different age groups|
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The prevalence of gingivitis and periodontitis among male was 54 (60%) and 28 (31.1%), and in female, it was 71 (57.3%) and 22 (17.7%), respectively, as shown in [Table 2].
|Table 2: Distribution of gingivitis and periodontitis among males and females|
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Smokers showed the prevalence of gingivitis 22 (49.6%) and periodontitis 19 (43.1%), whereas 44 (60.5%) and 31 (18.2%) nonsmokers suffered with gingivitis and periodontitis. On the contrary, only 3 (6.8%) smokers and 36 (21.2%) nonsmokers were having healthy periodontal conditions. Thus, significant differences were observed in the prevalence of gingivitis and periodontitis between smokers and nonsmokers (P < 0.05) as shown in [Table 3].
|Table 3: Distribution of gingivitis and periodontitis among smokers and nonsmokers|
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The prevalence of gingivitis and periodontitis among diabetic patients was 52.9% and 47.1%, respectively, while the prevalence of gingivitis and periodontitis among hypertensive patients was 35.72% and 56.13%, respectively. Among the hypothyroidism patients, the prevalence of gingivitis and periodontitis was 50% and 40%, respectively. Furthermore, patients having bronchial asthma, the prevalence of gingivitis and periodontitis was 85.74% and 0%, respectively. Similarly, in patients having Vitamin D deficiency, the prevalence of gingivitis and periodontitis was 66.67% and 0%, respectively. Hence, significant differences were observed in the prevalence of gingivitis and periodontitis among patients attending (P < 0.05) dental clinics as shown in [Figure 1]. Moreover, the prevalence of gingivitis and periodontitis among patients who do not regularly perform oral hygiene measures was 43.32% and 56.68%, respectively. The prevalence of gingivitis and periodontitis among patients performing toothbrushing regularly was 63.57% and 20.72%, respectively. Furthermore, the prevalence of gingivitis and periodontitis among patients with regular use of interdental aid was 52.27% and 9.09%, respectively [Figure 2].
|Figure 1: Prevalence of gingivitis and periodontitis in different systemic condition|
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|Figure 2: Prevalence of gingivitis and periodontitis among patients practicing oral hygiene|
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| Discussion|| |
This study was based on outpatients from Munisiya Dental Clinics of Riyadh Elm University during July 2017 to January 2018. It reported estimates of the prevalence of gingivitis and periodontitis among 214 (90 male and 124 female) patients. A convenient sampling methodology was applied to select the study participants attending outpatient dental clinics as a proxy to the general population. However, the prevalence assessed among these samples is higher than that assessed among the general population as persons with dental problems attend clinics, and they are not representative of the general population. The prevalence in the clinic-based population is about 10% higher as compared to that in the general population.
In general, the present study revealed that overall 125 (58.4%) patients were suffering with gingivitis and 50 (23.4%) having periodontitis. This result is lower than that reported by Idrees et al. among the adult patients attending clinics of private dental school in which gingivitis was reported to be 100%. This could be explained by the fact that the measuring tool for gingivitis differed between these two studies. Gingival index criteria of Loe and Silness were utilized in the former study, and on the contrary, the CPI criteria were applied in our study to evaluate the gingivitis. Similarly, higher prevalence of gingivitis (80%) was reported among children from Puerto Rico.
The present investigation indicated that the age and smoking status were considered important factors related to periodontitis. In agreement with the reported literature, the prevalence of periodontitis increased with age., The age-specific increase in the prevalence and severity of the periodontitis was due to the cumulative effect of periodontal breakdown over time. A decline in edentulism and a higher retention of the teeth in older age cohorts conceivably contribute to an increase in the prevalence of periodontitis. This is particularly evident when the periodontal damage is expressed in terms of clinical attachment loss. Moreover, as the age increases, individuals suffer from various medical problems and are treated with number of medications.
The present study findings indicated that the gingivitis is more common in 20–34-years old followed by 35–49-year-old and 50–64-year-old age groups. This is suggestive of the fact that gingivitis is more commonly affects younger age groups. On the contrary, periodontitis was very common in 50–64-year-old followed by 35–49-year-old and 20–34-year-old age groups. This finding clearly indicated that chronic periodontitis is detectable during the late ages of life.
Further, the relationship of age and periodontal disease showed that the severity of periodontal disease increased with the advancing age. These findings could be attributed to the general deterioration in immune function and tissue integrity in the older age that may increase the vulnerability to the periodontal disease.
These results are in line with other epidemiological studies on the prevalence of gingivitis and periodontitis among different age groups.,,,,, However, the results of this study showed some variation in the prevalence of the periodontitis compared to other reported studies. This variation may be due to the underestimation of periodontal conditions by considering partial periodontal examination and classification system that is solely based on probing depth values. Moreover, in this study, single experienced periodontist rather than general dentist conducted the periodontal examination of ten teeth.
Gender predominance was also observed in the prevalence of gingivitis and periodontitis. Males showed higher prevalence of gingivitis as well as periodontitis compared to the females. This could be due to the higher smoking habits among males compared to females. On the other hand, females tend to have higher dental visits and regular use of oral hygiene measures. This finding is similar to the results of study, in which periodontal disease was more common in males, and the reason suggested being the deleterious oral habits which are more prevalent in male population.
Among all the behavioral factors, smoking habit was found to be strongly associated with periodontitis., This finding is consistent with our findings that the prevalence of periodontitis was higher among smokers compared to nonsmokers population. It is important to highlight that in spite of the documented dose–response effect, no attempt was made to stratify current smokers based on the number of cigarettes smoked per day and the lifetime smoking exposure. This may have introduced an underestimation in the association between smoking and periodontitis.
It is widely documented that participants with diabetes mellitus have a higher risk of periodontal disease, and periodontal disease has been considered the sixth complication of diabetes. Extensive studies including the present study have reported significant associations between diabetes and the severity of periodontal disease.
Furthermore, the prevalence of gingivitis and periodontitis was seen higher among patients with no regular use of oral hygiene measures compared to patients with regular use of oral hygiene measures. This finding seems to agree with many epidemiological studies that showed higher correlation has been documented between attitudes toward oral hygiene and the progression of periodontal disease in which the greatest pocket depth scores were seen in the patients with irregular dental visits and no regular use of oral hygiene measures compared to patients with regular dental visits and regular use of oral hygiene measures.,
Recently, a study found that the number of medications had an effect on clinical attachment loss, and this effect was obvious when four or more medications were taken by the patients, suggesting possible synergism different drugs on periodontal responses. However, Needleman et al. in their review observed that the mean annual attachment level change varies significantly both within and between populations, and it is difficult to make differentiation between various forms of periodontal disease based on progression of attachment level.
Unlike other studies, the present study also has several limitations. In this study, dental patients seeking care in satellite dental clinics of teaching hospital were considered as study participants rather than individual from the population. Hence, they cannot be considered as true representative sample of population to generalize the prevalence of gingivitis and periodontitis. In this study, CPI index was used as a means to observe the periodontal disease status of the individuals. However, the use of CPI for population surveillance has a limitation to as a case definition for periodontitis. Community Periodontal Index mainly assesses the treatment need, hence used to record different treatment of periodontal condition at individual level. It does not give true prevalence rates in terms of severity and extent of the disease. Tooth loss or tooth mortality has not been assessed in this study as it could be a consequence of extent and severity of periodontal disease. Convenient sampling methodology could be another limitation of the study.
| Conclusions|| |
Within the limitation of the present study, it can be concluded that high prevalence of gingivitis was observed among relatively young age groups, while the prevalence of periodontitis is common among older age group. Higher prevalence of gingivitis and periodontitis was observed among males compared to females. Smoking habit and diabetic condition of the patients were found to be strongly associated with periodontitis. Irregular use of oral hygiene measures was considered among the risk factors of gingivitis and periodontitis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Albandar JM. Periodontal diseases in North America. Periodontol 2000 2002;29:31-69.
Krustrup U, Erik Petersen P. Periodontal conditions in 35-44 and 65-74-year-old adults in Denmark. Acta Odontol Scand 2006;64:65-73.
Meqa K, Dragidella F, Disha M, Sllamniku-Dalipi Z. The association between periodontal disease and preterm low birthweight in Kosovo. Acta Stomatol Croat 2017;51:33-40.
Turton M, Africa CW. Further evidence for periodontal disease as a risk indicator for adverse pregnancy outcomes. Int Dent J 2017;67:148-56.
Martín A, Bravo M, Arrabal M, Magán-Fernández A, Mesa F. Chronic periodontitis is associated with erectile dysfunction. A case-control study in European population. J Clin Periodontol 2018;45:791-8.
Carrizales-Sepúlveda EF, Ordaz-Farías A, Vera-Pineda R, Flores-Ramírez R. Periodontal disease, systemic inflammation and the risk of cardiovascular disease. Heart Lung Circ 2018. pii: S1443-9506(18)30597-3.
Pham TA, Tran TT. The interaction among obesity, type 2 diabetes mellitus, and periodontitis in Vietnamese patients. Clin Exp Dent Res 2018;4:63-71.
Daudt LD, Musskopf ML, Mendez M, Remonti LL, Leitão CB, Gross JL, et al.
Association between metabolic syndrome and periodontitis: A systematic review and meta-analysis. Braz Oral Res 2018;32:e35.
Pham T. The association between periodontal disease severity and metabolic syndrome in Vietnamese patients. Int J Dent Hyg 2018:1–8. Available from: https://doi.org/10.1111/idh.12350
. [Last accessed on 2018 Jul 3].
Qian XS, Ge S. The state of the art research findings on the relationship between chronic periodontitis and Alzheimer's disease: A review. Zhonghua Kou Qiang Yi Xue Za Zhi 2018;53:275-9.
Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim) 2017;11:72-80.
Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: A call for global action. J Clin Periodontol 2017;44:456-62.
Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999;70:13-29.
Nanaiah KP, Nagarathna DV, Manjunath N. Prevalence of periodontitis among the adolescents aged 15-18 years in Mangalore city: An epidemiological and microbiological study. J Indian Soc Periodontol 2013;17:784-9.
] [Full text]
Corbet EF, Wong MC, Lin HC. Periodontal conditions in adult Southern Chinese. J Dent Res 2001;80:1480-5.
Ainamo J, Barmes D, Beagrie G, Cutress T, Martin J, Sardo-Infirri J, et al.
Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). Int Dent J 1982;32:281-91.
Dayakar MM, Shivprasad D, Pai PG. Assessment of periodontal health status among prison inmates: A cross-sectional survey. J Indian Soc Periodontol 2014;18:74-7.
] [Full text]
Idrees MM, Azzeghaiby SN, Hammad MM, Kujan OB. Prevalence and severity of plaque-induced gingivitis in a Saudi adult population. Saudi Med J 2014;35:1373-7.
Elias-Boneta AR, Ramirez K, Rivas-Tumanyan S, Murillo M, Toro MJ. Prevalence of gingivitis and calculus in 12-year-old Puerto Ricans: A cross-sectional study. BMC Oral Health 2018;18:13.
Bali RK, Mathur VB, Talwar PP, Channa HB. National Oral Health Survey 2001-2003. 1st
ed. New Delhi: Dental Council of India; 2004.
Bourgeois D, Bouchard P, Mattout C. Epidemiology of periodontal status in dentate adults in France, 2002-2003. J Periodontal Res 2007;42:219-27.
WHO/FAO. Diet, Nutrition and the Prevention of Chronic Diseases. (WHO Technical Report Series). Report No.: 916. Geneva, Switzerland: WHO/FAO; 2002.
Tonetti MS, Claffey N; European Workshop in Periodontology Group C. Advances in the progression of periodontitis and proposal of definitions of a periodontitis case and disease progression for use in risk factor research. Group C consensus report of the 5th
European workshop in periodontology. J Clin Periodontol 2005;32 Suppl 6:210-3.
Genco RJ, Ho AW, Grossi SG, Dunford RG, Tedesco LA. Relationship of stress, distress and inadequate coping behaviors to periodontal disease. J Periodontol 1999;70:711-23.
Petersen PE. The World Oral Health Report 2003: Continuous improvement of oral health in the 21st
century – The approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 2003;31 Suppl 1:3-23.
Balaji SK, Lavu V, Rao S. Chronic periodontitis prevalence and the inflammatory burden in a sample population from South India. Indian J Dent Res 2018;29:254-9.
] [Full text]
Lee JH, Shin YJ, Lee JH, Kim HD. Association of toothbrushing and proximal cleaning with periodontal health among Korean adults: Results from Korea National Health and Nutrition Examination Survey in year 2010 and 2012. J Clin Periodontol 2018;45:322-35.
Burt B; Research, Science and Therapy Committee of the American Academy of Periodontology. Position paper: Epidemiology of periodontal diseases. J Periodontol 2005;76:1406-19.
Ojima M, Hanioka T, Tanaka K, Inoshita E, Aoyama H. Relationship between smoking status and periodontal conditions: Findings from national databases in Japan. J Periodontal Res 2006;41:573-9.
Soskolne WA, Klinger A. The relationship between periodontal diseases and diabetes: An overview. Ann Periodontol 2001;6:91-8.
Natto ZS, Aladmawy M, Alshaeri HK, Alasqah M, Papas A. Is there a relationship between periodontal conditions and number of medications among the elderly? Ghana Med J 2016;50:9-15.
Needleman I, Garcia R, Gkranias N, Kirkwood KL, Kocher T, Iorio AD, et al.
Mean annual attachment, bone level, and tooth loss: A systematic review. J Periodontol 2018;89 Suppl 1:S120-39.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]