Epidemiology Of Gingival And Periodontal Diseases
Question 1. Write in detail about epidemiology of periodontal diseases.
Answer. Epidemiology is “the study of the distribution and determinants of health-related states or events in specified populations and application of this study to control health problems”.
Epidemiologic data are collected with well-defied measuring systems known as indices. These indices have defied scales, are easily applied to population of individuals and measure some specific aspects of disease or condition of interest.
Indices of periodontal destruction measure factors beyond gingival changes, including bone loss around the teeth. These indices are used to estimate periodontal health for individuals, communities and populations. For assessing the epidemiology of periodontal diseases, various index are given, which are as follows:
- Periodontal index (Russell AL, 1956)
- Periodontal disease index (Ramfjord, 1959)
- Navy periodontal disease index (Grossman, 1974)
- Gingival periodontal index
- Extent and severity index (Carlos and coworkers):
- In India, data from the National Oral Health Survey (2002 – 2003) states that in children aged 12 years, the prevalence of periodontal disease was 57% and in the 15 year age group, it was 67.7%. The prevalence was 89.6% and 79.9% in 35 to 44 year age group and 65 to 74 year age group, respectively.
- Epidemiology can also be studied under host factors, agent factors and environmental factors.
Read And Learn More: Periodontics Question And Answers
Host Factors in Epidemiology of Periodontal Disease
Following are the host factors in epidemiology of periodontal disease:
Age
Prevalence of periodontal diseases increases with the increasing age. Greater prevalence and severity of periodontal disease in older people is due to cumulative progression of lesions over the time and not due to increased susceptibility in older individuals.
Sex
Males have high prevalence and severity of periodontal diseases as compared to females. As per the latest documentation pathogenesis of periodontal diseases indicates no difference between men and women in susceptibility to periodontitis.
Socioeconomic Status
High income group have lower prevalence of periodontal disease as compared to lower income group because they have means and can afford dental treatment. Lower socioeconomic status have poor diet, poor oral hygiene and lack dental awareness. They cannot afford the high cost of dental services and also the oral hygiene.
Diet and Nutrition
Sticky food adheres to the tooth and is difficult to remove. It interferes with self-cleansing process of oral cavity. These foods aggravate already existing periodontal problem. Nutrients associated with periodontal tissues are vitamin A, B complex, C and D, calcium and phosphorus.
Studies have demonstrated that there is high prevalence and severity of periodontal disease in areas where protein-calorie malnutrition and vitamin A deficiency is common.
Anatomy
- Health of gingiva and periodontium depends on correct form and position of the teeth in the dental arch. The normal contour of tooth protects the underlying tissues.
- In tooth poor cuspal anatomy, uneven marginal ridges, lack of contact between teeth and crowding can cause food impaction and accumulation causing the underlying gingival tissue to become irritated and inflamed resulting in periodontal disease.
- In soft tissue when frenum is inserted close to the marginal gingiva, pull of this attachment may cause recession of interproximal papilla. Proximity of frenum to marginal gingiva interferes with proper use of toothbrush in the area.
Habits
- In unilateral mastication, one side of the oral cavity is affected by periodontal disease to a greater degree. Due to tooth extractions, pain and discomfort, patient starts chewing over the healthy side which results in unilateral mastication. Due to this, one side of mouth is healthy, clean and is in proper function while over the neglected side tissue tone gets lost, accumulation of food, debris and calculus is seen.
- Abnormal habits such as putting pencil, finger nail, toothpick in the mouth. Opening of bobby pins, lip biting, cheek biting, occupational habits causes trauma to the periodontium.
Systemic Factors
- Uncontrolled diabetes and heavy metal poisoning leads to gingivitis and periodontitis.
- Acute monocytic leukemia may produce gingival enlargement and ulceration.
- AIDS and HIV increase susceptibility for destructive periodontal disease.
Local Irritants
Mechanical Irritants: Faulty toothbrushing can lead to abrasion of teeth and recession of gingiva and also irritate already inflamed tissues.
Faulty dentistry such as overhanging margins of any restoration or open cavity margins impinge on gingiva or irritate them.
- Faulty orthodontic treatment also results in root resorption as well as alveolar bone loss and mobility.
- Chemical irritants: Alcohol, tobacco and condiments directly lowers tissue and increases gingival susceptibility to gingivitis and periodontal diseases.
- Atmospheric irritants: Because of obstruction in nasal passage, habit, malocclusion, systemic disturbances and psychosomatic factors some patients breathe through the mouth. Dehydration of mucous membrane leads to lowered tissue resistance.
Agent Factors in Epidemiology of Periodontal Disease
Agent factors are dental plaque and calculus.
Dental Plaque
- It is defined as structured, resilient, yellow grayish substance that adheres tenaciously to the intraoral hard surfaces, including removable and fied restorations.
- Plaque is composed of bacteria in a matrix of salivary glycoproteins and extracellular polysaccharides. It is due to this matrix plaque cannot be removed by rinsing.
- Dental plaque is classified as supragingival and subgingival plaque.
Plaque Biofilm
- It is a well-organized co-operating community of microorganisms.
- They are composed of micro-colonies of bacterial cells non-randomly distributed in a matrix.
- Plaque biofilm has open fluid-filed channels running through the plaque which permits passage of nutrients and other agents.
- Intercellular matrix consists of organic and inorganic materials derived from saliva, gingival crevicular fluid and bacterial products.
- Matrix functions as a barrier to retain and concentrate the substances produced by bacteria.
Calculus
- It is a hard deposit which is formed by mineralization of dental plaque and is covered by a layer of unmineralized plaque.
- Calculus can be classified as subgingival and supra-gingival.
- Supragingival calculus is located coronal to the gingival margin and is white or whitish yellow in color and has hard clay-like consistency which can be detached from the tooth.
- Subgingival calculus is located below the crest of marginal gingiva, is dark brown or greenish black in color and is hard and dense which is firmly attached to tooth surface.
- Mineralization of dental plaque leads to formation of calculus.
Environmental Factors in Epidemiology of Periodontal Disease
Geographic Variation
Studies show differences in susceptibility to periodontal disease between the nations. Russell described population according to whether disease is relatively high, intermediate or relatively low. However, the WHO Global Oral Health Data Bank should not implicate any difference between nations and therefore race and ethnicity cannot be considered as risk factors for periodontal disease.
Degree of Urbanization
It is related to periodontal disease. Studies shows that people residing in rural areas has significantly higher prevalence of periodontal disease than did urban people.
Psychological and Cultural Factors
Anxiety, fear of dentist, lack of knowledge about diseases and their treatment are some relevant psychological factors. Various culture view dental problems and loss of teeth solely as an extension of aging process.
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