Maaz Asad1 – BDS, MDSc
Asaad Javaid Mirza2 – BDS, MCPS, MDS
Ammar Siddiqui3 – BDS, MDPH
Marwah Berkath4 – BDS
Saadia Saad5 – BDS
Khalid Shafiq6 – BDS
BACKGROUND: Periodontal diseases are more prevalent in developing countries than in developed countries. According to a WHO report, despite all good efforts oral health problems still persist among underprivileged communities. Gadap is a rural, under privileged community of Karachi, Pakistan where paucity of oral and general health facilities prevails. This study has been carried out to explore periodontal status in the Gadap – an area of low socioeconomic population and to establish association of age and gender with BPE scores.
RESULTS: The sample size was 1253 subjects including 64.9% males and 35.1 % females. There were no significant association between gender and BPE score. Males had higher percentages of code 1 and 2 (Gingivitis) and code 3 and 4 (Periodontitis 10.1%). Females had gingivitis (28.8%) and periodontitis (5%). Results show significance between the age and the BPE scores. Percentage of healthy individuals (code 0) without any pocket formation, bleeding or calculus is 5%. The other prominent finding (code 1 and 2) that is presence of calculus and pockets of less than 3.5mm in 80% of the subjects suggesting gingivitis. Subjects affected with periodontitis are 15%. According to specific age higher cases of gingivitis (48.1%) are reported between 18-30 years and periodontitis (4.62%) are reported between 31-40years.
CONCLUSION: Prevalence of periodontal diseases among young population of 18 – 30 years age group is very high.
KEYWORDS: Prevalence of Periodontal diseases, Periodontal profiles, Basic periodontal examination.
HOW TO CITE: Asad M, Mirza AJ, Siddiqui A, Berkath M, Saad S, Shafiq K. Periodontal Status of the Residents of a Rural Community in Gadap Town, Karachi, Pakistan. J Pak Dent Assoc 2016; 25(3): 93-97.
Received: 10 August 2016, Accepted: 29 September 2016
Diseases affecting integrity of Periodontium are universally widespread and are categorized as Periodontal Diseases. The periodontal diseases if left untreated become an irreversible malady that causes everlasting destruction of involved periodontal tissues. The occurrence of the disease differs in various parts of the sphere. It has also been reported that periodontal diseases are more prevalent in developing countries than in developed countries1 . There are many risk factors involved with prevalence of periodontal disease as age, gender, brushing habits and tobacco smoking2,3. Data providing information of the periodontal status and associated risk factors helps the dental professionals and policy makers to identify high risk communities for periodontal diseases and to commence strategic planning for a pre-emptive and therapeutic treatment program.
A WHO report expresses that oral health problems still persist even among underprivileged communities in developed western countries and many developing countries have a shortage of oral health personnel where very little importance is given to preventive or restorative dental care4 . Gadap Town, situated in northwestern part of Karachi is the largest but the most under privileged and socioeconomically deprived town. It is populated with around 300,000 inhabitants. The town lacks basic amenities like perennial supply of natural gas, drinking water and electrical power. The general health facilities are scarcely available. In such scenario, how may one think about water and electrical power. The general health facilities are scarcely available. In such scenario, how may one think about existence of oral health services? Keeping this in mind, a crosssectional study to provide a basic data base has been conducted involving the patients of Gadap area attending Baqai Dental College Hospital.
Diagnosis of periodontal disease involves a comprehensive full mouth examination consisting of Probing pocket depth and gingival attachment levels5. Since this full mouth examination is extensive, time consuming and often requires assistance for recording, British Society of Periodontology established Basic Periodontal Examination (BPE) to carry out Basic Screening Procedure for rapid detection and reliable diagnosis. It is widely employed in the United Kingdom and New Zealand. Many other Periodontal Indices also exist which are in use in different countries. Community Periodontal Index for Treatment Needs (CPITN) has been employed by many researchers for the diagnostic purpose6 . American Society of Periodontology established Periodontal Screening and Recording (PSR)7 which is largely used in the USA, Canada and Brazil. The Primary Essential Periodontal Examination (PEPE) is followed in Australia. Some of the studies have reported drawbacks for under and overestimation of periodontal conditions using these indices whereas others have considered it as valuable tool in early diagnosis of periodontal conditions8.
This study was carried out utilizing Basic Periodontal Screening (BPE) which helps to determine need of comprehensive periodontal examination and treatment9. The objectives of this study were to explore periodontal status in the Gadap region and to establish association of age and gender with BPE scores.
MATERIAL AND METHODS
This study was conducted from the patients who attended OPD at the Department of Periodontology, Baqai Medical University between September 2015 to June 2016. Ethical approval for this study was granted by dental ethics committee, Baqai Medical University. Patients who did not provide consent for examination and treatment, patients who did not receive complete oral examination including BPE, Patients with edentulous arches or furcation involvement and patients not living in Gadap were excluded from the study. Following exclusion criteria 1253 patients were registered for treatment at Baqai Dental College Hospital during the above specified time and were included and were considered as sample of the study. They were divided in to 4 groups according to their ages as follows (18-30, 31-40, 41-50 and 51-60) years.
Two dental officers performed BPE who were calibrated prior to the examination (Kappa value > 0.8). Upper and lower arches were divided into 6 sextants: first sextant, 14-17; Second sextant, 13-23; Third sextant, 24-27; fourth sextant, 37-34; Fifth sextant, 33-43; Sixth sextant, 44-47. Each tooth was probed on 6 sites (distofacial, midfacial, mesiofacial, distolingual, midlingual and mesiolingual). WHO probe was inserted into the gingival sulcus and the scores were designated ranging from 0 to 4 on the criteria listed below:
0 = No pockets >3.5mm (Black band is completely visible), no bleeding and no calculus.
1= No pocket >3.5mm (Black band is completely visible), no calculus but there is bleeding on probing.
2= No pockets >3.5mm (Black band is completely visible), but there is calculus.
3= Probing depth between 3.5mm and 5.5mm (Black band partially visible).
4= Probing depth >5.5mm (Black band is completely hidden. *= Furcation involvement
Highest score on any sextant was considered as the likely diagnosis of the patients’ periodontal condition and were coded as the following:
Code 0= Healthy; Code 1, 2 = Gingivitis and Code 3, 4 = Periodontitis
The obtained results were displayed as number and frequency. For inferential statistics Chi Square test was employed to determine association between BPE scores with gender and mentioned age groups.
The data was gathered using a BPE chart designed for the application in Periodontics Department of the institution. The data was entered and analyzed using SPSS version-20. The sample size was 1253 subjects including 817 (64.9%) males and 436 (35.1 %) female. There were no significant findings observed between genders for any of the BPE score. However, male subjects had higher percentages of code 1 and 2 indicative of periodontal disease that is confined to gums (gingivitis 51.2%) and code 3 and 4 indicative of periodontal disease extending to supporting structures (Periodontitis 10.1%) when compared with females that have gingivitis (28.8%) and periodontitis (5%) respectively Table 1.
BPE scores in respect to the age of the study subjects are shown in Table 2. The data shows significance between the age and the BPE scores with p Value less than 0.005. The table shows that percentage of perfectly healthy individuals (code 0).
without any pocket formation, bleeding or calculus is merely 5%. The other prominent finding (code 1 and 2) that is presence of calculus and pockets of less than 3.5mm in 80% of the subjects suggesting gingivitis. Subjects affected with periodontitis are 15% (code 3 and 4). According to specific age higher cases of gingivitis (48.1%) (code 1 and 2) are reported between 18-30 years and periodontitis (4.62%)(code 3 and 4) are reported between 31-40 years.
Participation of males in this study was higher (around 65%) in comparison to the females (35 %). The results show that periodontal diseases are more common in males where trends were higher for gingivitis (51%) and periodontitis (10%) which when compared with females who have relatively lower percentages with gingivitis occurring in 29% and periodontitis occurring in 5% individuals. These findings were in accordance with previous studies which reported that males are more severely affected with periodontal disease than females10,11. However, the findings observed were not significant. Though the differences have not been explained in detail anywhere but it is generally believed that males exhibit poor oral hygiene than females12. The thinkable cause for the slackness shown from males to retain oral hygiene could be the workload on them which they endure for being the single earning member for their whole large families13. Secondly, using tobacco in any form is more common among males and is an established risk factor for periodontal diseases which has a direct adverse effect on periodontal condition of a tobacco user14.
The findings of the study on association between age and BPE scores is very highly significant with p value of 0.00001. These findings match the findings of many previous studies done in this regard15,16. Most striking aspect of the findings is that the periodontally healthy individuals, who belong to a rural community, were a few (hardly 5%). Moreover, majority of the youth (18 – 30 years of age) of the same community suffers from one or the other form of periodontal diseases (Table 2). This is in contrast to results of a Turkish study which reveal that majority of the Turkish youth has healthy periodontal status17. Pockets of less than 3.5 mm depth with calculus (code 2) is the commonest befalling in young adults age group. These findings are not very different from the findings of the study performed in Madagascar (18) and are further corroborated by another study19 done in students of secondary schools in Pakistan.
A path- finder study20 done in Pakistan under auspices of WHO shows that among kids of 12-15 years of age group, 32% had healthy periodontium in year 1991. The findings of this study are suggestive of the fact that since the path finding survey was done in Pakistan, nothing has been done in this regard to improve the oral health. On the contrary, periodontal status seems to have further deteriorated. It is not very unlikely that if samples from population of other rural areas are studied,similar results will be achieved. Leaving the situation in situ at this alarming stage will put general health of the rural population in jeopardy as it has been documented that periodontal diseases are strongly associated with Carotid Atherosclerosis21, risk of adverse pregnancy consequences22, respiratory diseases and diabetes mellitus23. The foremost reason for prevalence of such high periodontal ailments in Gadap population may be its socioeconomic status as the impact of socioeconomic standing of a person plays a substantial role in retaining or not retaining good oral health24. The other collaborating factors may be illiteracy, cultural constraints, lack of public policies, restricted resources of the health sector, low human development in the country, competing health priorities and low-priced accessibility of betel quid and areca nut25.
WHO introduced The Community Periodontal Index (CPI)26 to provide profiles of periodontal health status in countries and to facilitate them to plan interventional programs for effective control of periodontal disease. In the past twenty years, numerous countries have provided CPI data to be kept in the WHO Global Oral Health Data Bank27 and they are displayed through WHO Country/Area Profile Program(CAPP) by University of Niigata, Japan. It is surprising to note that in the latest display of periodontal profile of countries by Niigata University, CPI of Pakistan is not included28. The reason behind may be lack of valid and authentic data by any competent authority or professional organization.
This study suggests rising prevalence of periodontal disease and indicating higher periodontal treatment needs for the population. The data strongly recommends that it is timely and prudent that the disease is given its due attention and CPI of Pakistan is introduced. Evaluation using these indices will help in identifying and classifying periodontal disease rapidly thus periodontal treatment needs can be assessed.
Prevalence of periodontal diseases especially in rural youth is very high and requires immediate attention of the concerned authorities before disease burden becomes unmanageable.
CONFLICT OF INTEREST
- Serious efforts to stabilize the precarious oral health conditions in the rural populations by the concernedauthorities/stakeholders are required. No agency can address the enormous task. Public Health Department, Professional associations and Dental Schools should take up this task jointly.
- Oro-dental health educational programs should be launched at community levels for prevention of oral and periodontal diseases.
- Corbet EF, Zee KY, Lo E. Periodontal diseases in Asia and Oceania. Periodontol 2000. 2002; 29: 122-52.
- Bagińska J, Wilczyńska-Borawska M, Stokowska W. The evaluation of CPITN index among adults living in Podlasie region. Adv Med Scien. 2005; 51: 119-21.
- Hyman JJ, Reid BC. Epidemiologic risk factors for periodontal attachment loss among adults in the United States. J Clin Periodontol. 2003; 30: 230-7.
- Petersen PE, Ogawa H. Strengthening the prevention of periodontal disease: the WHO approach. J Periodontol. 2005; 76: 2187-93.
- KS P, SR E, TK B. Periodontal Screening and Recording (PSR) Index Scores Predict Periodontal Diagnosis. J Dent App. 2014; 1: 8-12.
- Ainamo J, Barmes D, Beagrie G, Cutress T, Martin J, Sardo-Infirri J. Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). Int Den J. 1982; 32: 281-91.
- Landry R, Jean M. Periodontal Screening and Recording (PSR) Index: precursors, utility and limitations in a clinical setting. Int Dent J. 2002; 52: 35-40.
- Landry RG, Jean M. Periodontal Screening and Recording (PSR) Index: precursors, utility and limitations in a clinical setting. Int Den J. 2002; 52: 35- 40.
- Mathews DP, Kokich VG, editors. Managing treatment for the orthodontic patient with periodontal problems. Seminars in orthodontics; 1997: Elsevier.
- Haber J, Wattles J, Crowley M, Mandell R, Joshipura K, Kent RL. Evidence for cigarette smoking as a major risk factor for periodontitis. J Periodontol. 1993; 64: 16-23.
- Brown LF, Beck JD, Rozier RG. Incidence of attachment loss in community-dwelling older adults. J Periodontol. 1994; 65: 316-23.
- Abdellatif H, Burt B. An epidemiological investigation into the relative importance of age and oral hygiene status as determinants of periodontitis. J Dent Res. 1987; 66: 13-8.
- Holtfreter B, Schwahn C, Biffar R, Kocher T. Epidemiology of periodontal diseases in the Study of Health in Pomerania. J Clin Periodontol. 2009; 36: 114- 23.
- Bergström J. Cigarette smoking as risk factor in chronic periodontal disease. Comm Dent and Oral Epidem. 1989; 17: 245-7.
- Niessen LC, Fedele D. Aging successfully: oral health for the prime of life. Comp Cont Edu Dent (Jamesburg, NJ: 1995). 2002; 23(10 Suppl): 4-11.
- Albandar J, Brunelle J, 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.
- Gökalp S, Guciz Dogan B, Tekçiçek M, Berberoglu A, Ünlüer Ş. National survey of oral health status of children and adults in Turkey. Comm Dent Health. 2010; 27: 12.
- Petersen PE, Razanamihaja N. Oral health status of children and adults in Madagascar. Int Dent J. 1996; 46: 41-7.
- Ali M. Prevalence of Periodontal diseases among secondary school children (9-18 years). Ann Abb Shah Hosp Kar Med Dent Coll. 2004; 9: 521-3.
- Maher R. Dental disorders in Pakistan–a national pathfinder study. J Pak Med Ass. 1991; 41: 250-2.
- Söder P-Ö, Söder B, Nowak J, Jogestrand T. Early carotid atherosclerosis in subjects with periodontal diseases. Stroke. 2005; 36: 1195-200.
- Offenbacher S, Boggess KA, Murtha AP, Jared HL, Lieff S, McKaig RG, et al. Progressive periodontal disease and risk of very preterm delivery. Obst & Gyn. 2006; 107: 29-36.
- Anil S, Al-Ghamdi HS. The impact of periodontal infections on systemic diseases. An update for medical practitioners. Saud Med J. 2006; 27: 767-76.
- Gundala R, Chava VK. Effect of lifestyle, education and socioeconomic status on periodontal health. Cont Clin Dent. 2010; 1: 23.
- Harchandani N. Oral health challenges in Pakistan and approaches to these problems. Pak Oral Dent J. 2012; 32 :497-501.
- WHO. Oral Health Surveys: Basic Methods, 4th edn. Geneva: World Health Organization, 1997. Baseline Characteristics of PAES Dental Program Participants. (377).
- WHO. Global Oral Health Data Bank. Geneva: WHO; 2001. 2010.
- WHO. Periodontal country profiles. 2005.
1. Assistant Professor, Department of Periodontology, Baqai dental college, Karachi, Pakistan.
2. Professor, Department of Restorative Dentistry, Ha’il University, KSA
3. Lecturer, Department of community Dentistry, Ha’il University, KSA
4. Postgraduate Student, Department of Restorative Dentistry, University of Malaya, Malaysia
5. Private Dental Practitioner, Dubai 6. Senior Lecturer, Department of Operative Dentistry, Baqai dental college, Karachi, Pakistan Corresponding author: “Dr. Maaz Asad” < email@example.com >