Prevalence and Severity of Periodontal and Oral Hygiene Status among 30-40 Years Old Adult Population Attending A Private Dental College- A Hospital Based Cross Sectional Study

Keywords

Oral Hygiene; OHIS Index; Periodontitis; Russell’s Periodontal Index.

Introduction

Periodontitis or periodontal infection is defined as an inflammatory disease of the supporting tissues of teeth caused by specific microorganisms resulting in destruction of the periodontal ligament and alveolar bone with periodontal pocket formation [1]. This is a complex infectious disease due to bacterial interaction with the host immunity responses. This infection is initiated by specific invasive oral pathogens in the oral cavity. They colonise and form dental plaque biofilms and calculus on the tooth’s surface. The individual's host immune response plays a major role in the disease pathogenesis. Dental plaque is an example of both biofilm and microbial communities [2]. There are diversity ties of bacterial species belonging to various periodontal flora of different complexes [3]. The common organisms are the P. gingivalis, A.actinomycetemcomitans, B.forsythus and Treponemas [4]. These species colonise in the oral cavity leading to destruction.

Oral hygiene maintenance is important to prevent diseases in the oral cavity. Generally periodontal diseases are more commonly seen in men, due to their oral habits like tobacco smoking and other common reasons being stress and medications. The bacterial infections when aggravated by habits like smoking can lead to periodontitis. This is one of the most common diseases of the oral cavity besides gingivitis [5]. Periodontal diseases are majorly seen among the older age group due to the poor oral hygiene, diabetes, medications, hereditary, lack of dental care and age related diseases. Poor oral health associated with periodontal diseases can have an adverse effect on the individual’s systemic health like CVS diseases, Diabetes, whereas in females, this is seen to be associated with pregnancy related problems, whereas in children, it is seen in the form of dental caries rather than periodontitis [6]. In children, this can be prevented at an early age with the help of sealants that form resin tags on the tooth and proper oral maintenance [7-10].

Dental caries are a widespread disease seen equally in men and women. Treatment for prevention of dental caries in both adults and children is the use of optimal fluoride containing toothpaste [11, 12]. Tobacco in the form of smokeless form or smoking form is the main reason for poor oral hygiene statuses seen in men. Negative effects of smoking such as cigar, pipe etc can also have effects on oral health [13, 14]. Studies have shown that smokers are at 3 times greater risk than the non smokers [15]. Lack Of proper tooth brushing can lead to plaque deposition [16]. Recent advances such as the toothpastes containing Nova min, Bio min, Remin Pro have been proven to reduce the caries progression [17]. The usage of Poor oral hygiene is linked to periodontal diseases. Nutrition plays a major role in maintaining the balance between the body and oral health [18]. This leads to accumulation of dental plaque and calculus [19]. Females are also equally affected. Normally, the high prevalence in middle aged women is mostly seen during their menstruation and at menopausal stages due to high levels of progesterone levels [20]. Another reason being the stress, which reduces the flow of salivary secretions leading to dental plaque formation [21, 22]. This leads to the progression of dental caries and adhesion of bacteria on the tooth surface [23]. There are various by which this can be treated. Individuals who lack accessibility to dental care can maintain their oral hygiene at home with the recent advances like green tea mouth rinse and other herbal formulations that prevent plaque deposition [24, 25].

There were various complications of periodontal diseases associated with poor oral hygiene. This can affect systemic health due to various risk factors. Therefore, the aim of this study was to assess the prevalence of periodontal disease status on oral hygiene status among the adult population.

Materials And Methods

Statistical Analysis

This present study was a descriptive, record based study conducted in a university setting at Saveetha dental college, Chennai . Case sheets of all the Patients of OP Department of Saveetha dental college were reviewed for a period of two months [June 2019 and April 2020]. Simple Random Sampling was carried out to select a total of 187 patients. This retrospective study was approved by the following ethical approval number of the university, SDC/ SIHEC/2020/DIASDATA/0619-0320. The sampling bias was minimised by using a simple random technique of data collection. The internal validity of the study was the random selection of subjects and universally accepted Russell’s periodontal index and OHI-S index.

Assessment of Periodontal disease was carried out using Russell’s periodontal index by Russell AI for permanent dentition. The tooth was scored according to the criterias into 0 (negative), 1 (mild gingivitis), 2 (gingivitis), 4 (used only when radiographs are available), 6 (gingivitis with pocket formation) and 8 (advanced destruction with loss of masticatory function). The total of these scores was then calculated and assigned Clinically normal suppurative tissues (0-0.2), Simple gingivitis (0.3-0.9), Beginning destructive periodontal disease (1-1.9), Established destructive periodontal disease (2-4.9) and Terminal disease (5-8).

Assessment of Oral hygiene was carried out using an oral hygiene index simplified (OHI-S) by Greene and Vermillion for permanent dentition. The tooth was scored according to the presence of debris and calculus present and given scoring of 0, if there were no debris or stains present, 1 if there was soft debris or calculus covering not more than one third of tooth’s surface, 2 if there was soft debris or calculus covering more than one third of tooth’s surface, 3 if there was soft debris or calculus covering more than two thirds of tooth’s surface. The total of these scores was then calculated separately and assigned good (0-1.2), fair (1.3- 3) and poor (3.1-6).

Data collection/Tabulation

The data was then entered in MS Excel Sheets and excel tabulation was done. The data was then imported to SPSS. Graphical and table illustration was done by variable definition process.

Statistical Analysis

The statistical tests used were the descriptive and inferential statistics. The software used was the IBM SPSS Version 20.0. The dependent variables were the Periodontal Index and OHI-S whereas the independent variables were the age and gender. Descriptive statistics were expressed by means of frequency, percentage, mean and standard deviation. Independent t-test was used to compare the mean Periodontal Index and OHIS score with age and gender respectively. Pearson correlation was used to find the relationship between Periodontal Index and OHIS score.

Results And Discussion

In the present study, from Figure 1, 36% of subjects belonged to the 30-34 years age group and 64% of subjects belonged to the 35-40 years age group and from Figure 2, 39.8 % of subjects were females and 60.2% of subjects were males. From Figure 3, it is observed that among 30-34 years, the mean value was (2.3 ±2.92) whereas in 35-40 years, the mean value was (4.5±3.59) respectively. There was a statistically significant difference observed on comparison of age with mean Russell’s periodontal index using Independent t-test. From Figure 4, on comparison between gender with mean Russell’s periodontal index, females (5.0±1.45) were more prone for caries than males (2.9±2.46) with a p-value less than 0.05 and were found to be statistically significant. From Figure 5, On comparison between age and mean OHIS , it is observed that among 30-34 years the mean is (2.16±0.87) whereas in 35-40 years, the mean is (2.47±0.85) with a p-value of 0.99 having an insignificant association. From Figure 6, on comparison between gender with mean OHIS, there was no much difference among the females (2.12±0.90) and males (2.09±0.84) with a pvalue of 0.00 and were found to be statistically significant.

Periodontitis is a constant potential source of infection in poor oral hygiene. This disease has a greater risk in systemic health [26]. Chronic periodontitis/ localised periodontitis is an infectious inflammatory disease with potential risk factors and complications [27]. Children, adolescents and adults can be equally affected with this disease [28]. Fair to poor OHI-S scores shows persistent increase in the periodontal index score. Higher scores were seen in the beginning of periodontal destruction, which means that the periodontal destruction is correlated with poor oral hygiene [29].

---

---

---

---

---

---

---

---

---

---

---

---

Good oral hygiene and oral care habits should be promoted in public health campaigns. Periodontal diseases can be prevented if one understands its complications [30]. Goal setting, self-planning is important. People should monitor their local hygiene [31]. Age is one of the most common risk factors. It is commonly seen in the older age group and increases with age [32]. Periodontal diseases are seen with increased bone loss, commonly due to accumulation of plaque and this eventually results in tooth mobility [33]. Sex also plays a major role , especially in males with oral habits than femals which predisposes to periodontal diseases [34]. Genetics play a role in the juvenile and aggressive periodontics with poor oral hygiene. This is significantly associated with adults [35]. Studies have been conducted by the United States showing 80% are prevalent in the older age group [36].

The OHI-S was assessed using both the soft and hard deposits and this study was similar to a study done with fair status showing high prevalence [37]. Public health services play a role in eliminating this disease and by creating awareness of the complications and management strategies [38]. There are various approaches for treating this disease. Main step in the prevention of this disease is by proper tooth brushing and flossing [39] followed by supragingival irrigation by scaling [40] and subgingival irrigation [41]. Periodontal scaling procedures are done to remove the calculus and plaque on the tooth. This is a mechanical type of irrigation. Root planing is also done alongside scaling [42]. This helps in pocket regression. Other various techniques are the host modulation [43] and antimicrobial therapy [44]. Public awareness must be created in order to reduce the mass disaster caused due to dental caries and poor oral hygiene [45]. The limitations of this study was the small sample size and geographic limitations. The future scope of this study is to create awareness on the effect of periodontal disease status on poor oral hygiene status among adults.

Conclusion

Therefore, in conclusion, periodontal diseases are highly prevalent in the adult population, commonly in males (60.22%) among the 38-40 years age group with poor oral hygiene.

Acknowledgement

The authors would like to acknowledge the support rendered by The Department of Public Health Dentistry of Saveetha Dental College and Hospitals and the management for their constant assistance with the research.