Prevalence Of Gingivitis During Circumpubertal Period Of 18-20 Years - A Retrospective Study

Keywords

Circumpubertal Period; Gingival Index; Gingivitis; Plaque Index; Prevalence.

Introduction

Oral health maintenance is essential to maintain overall health of the body. Periodontal diseases and dental caries are considered as multifactorial diseases which cause serious effects in the oral health of the patients [1]. They are one of the most prevalent oral diseases which can easily affect the individual whose oral hygiene is not maintained properly. If a periodontal diseases are not treated on time, it may cause destruction to tooth, soft tissues and bone [2].

Gingivitis is a reversible dental plaque induced inflammation of the gingiva without any bone loss and clinical attachment loss. It is one of the most frequently encountered cases in a dental practice affecting individuals of all ages [3]. Untreated gingivitis can progress to periodontitis. But not all gingivitis will progress to periodontitis. Endotoxins produced by the pathogens of subgingival flora are the prerequisite for periodontal diseases [4]. Gingivitis is caused by multiple factors in which one or more factors together causes inflammation to the soft tissues of the periodontium [5]. These factors include bacteria, biofilm, genetic, socioeconomic, demographic, iatrogenic and behavioural factors [6]. However plaque induced gingivitis is the most common form of periodontal diseases [7].

Children and adolescents are affected by various forms of periodontal diseases including chronic gingivitis, localised or generalised aggressive periodontitis, etc [8]. Chronic gingivitis is the most common periodontal infection in children and adolescents. It can occur in various forms in children, which can be aggravated by many factors which includes plaque, steroid hormones, drugs etc,[3]. The prevalence and incidence of gingivitis varies with different countries and different studies due to the variation in the study population, age and research methodology. Several studies have shown that the prevalence of gingivitis increases markedly during puberty. During adolescence, there appears to be an increase in the prevalence of gingivitis varying from 50-90% [9, 10]. The clinical examination and several indices are used for determining the severity of the gingival inflammation. Gingival index and plaque index have been used widely to characterise the disease. Though its reliability is still unclear [1], the presence of these signs of inflammation is considered as the initial stage for more severe and irreversible forms of periodontal diseases [11].

Gingival inflammation can be prevented by maintaining good oral hygiene with proper dental plaque control. Since, gingival inflammation is considered to be a prerequisite for the development of periodontitis, impelling personal plaque control may be appraised as a primary prevention strategy to conflict the occurrence of periodontitis [12].

Prevention of dental plaque and early treatment of gingivitis reduced the risks of developing into more severe stages of periodontal diseases. It is necessary to collect detailed data regarding the gingivitis, to eliminate the factors which influence its incidence in the population.Previously our team has a rich experience in working on various research projects across multiple disciplines [13-27]. Hence, the aim and objective of the present retrospective study is to evaluate the prevalence of gingivitis during circumpubertal period in the age group of 18-20.

Materials And Methods

Sampling

This study was conducted in a university setting. The study samples were chosen from the patients visiting a hospital in Chennai from June(2019) to March(2020).

Data collection

The retrospective study was carried out among patients of age group 18-20. Data collection was done through reviewing the records of 86000 patients between June (2019) - March (2020). A total of 37 patients reported with gingivitis in the age group of 18-20 with complete data. Data such as patient’s age, gender, gingival index, plaque index were noted.

Inclusion criteria

Only the patients aged 18-20 years visiting the hospital with complete data were included.

Exclusion criteria

Patients with severe systemic diseases, periodontitis and under special care were excluded.

Patients who are not recorded with plaque and gingival index with the presence of gingivitis were excluded.

Incomplete/censored data were excluded too.

Approval

Ethical clearance was obtained from the Institutional Scientific Review Board of the Saveetha University(SDC/SIHEC/2020/ DIASDATA/0619-0320).

Data analysis

The data collected was entered in the excel sheet and transferred to SPSS software. Data was analysed using SPSS software though frequency distribution and Chi-square tests.

Results And Discussion

In the present study, 37 patients presented with gingivitis in the age group of 18-20. Among them 35.14% of the patients were 19 years old and 32.43% of the patients belonged to 18 and 20 years of age(Graph 1). Among them, the prevalence of gingivitis was more among males(70.27%) than females(29.73%)(Graph 2). About 56.76% of the patients presented with fair oral hygiene, 29.73% of the patients presented with good oral hygiene and about 13.51% of the patients presented with poor oral hygiene. The mean score of the plaque index(PI) was 1.31.

About 45.95 of the patients had moderate gingivitis, 29.73% had mild gingivitis and about 24.32% of the patients had severe gingivitis. The mean score of the gingival index(GI) was 1.47.

There was a higher prevalence of moderate gingivitis in the study population, which is statistically significant (Chi-square; p<0.05) (Graph 3). The gingival index was comparatively higher among males than the females. Severe gingivitis was more prevalent among males (Graph 4).

In the present study, oral hygiene status based on plaque index decreases as the age increases. There was a higher prevalence of fair oral hygiene in the study population (Graph 5). There was a statistically higher prevalence of poor oral hygiene among males than females (Graph 6). There was a statistically significant association between plaque index and gingival index. Moderate gingivitis were more prevalent with higher prevalence of fair oral hygiene. Gingivitis is a reversible and non-destructive form of periodontitis usually presented with inflammation in marginal gingival which may progress to include attached gingiva but causing no attachment loss [28]. It can be acute or chronic in nature, occurring in all age groups. Diagnosis of various types of gingivitis mainly relied on the clinical findings and manifestations including redness, edema of the marginal gingiva, and bleeding upon probing [29]. If the disease persists, margin may become rolled with bulbous and enlarged interdental papilla and spontaneous bleeding with increased probing depth [30]. Gingivitis may exhibit various patterns of signs and symptoms of inflammation that are mainly localised to gingiva. However, systemic factors including endocrinopathies, hematological conditions, diet, drugs etc can modify the inflammatory response [31]. Gingivitis during puberty gets exacerbated due to the increase in the level of oestrogen and testosterone in the gingival tissues. The cytoplasm of the gingival cells contains specific high affinity, low capacity receptors for both oestrogen and testosterone. Thus, causing vasodilation and proliferation which results in causing increased vascularity leading to the increased susceptibility to inflammation in the presence of local factors [32, 33]. The incidence and severity of gingivitis in adolescents are influenced by a variety of factors such as plaque levels, dental caries, crowding of the teeth, mouth breathing and tooth eruption [34]. However, numerous studies reported an increase in the incidence of gingivitis in circumpubertal period due to the dramatic rise of steroid hormones in both genders irrespective of the presence of plaque [10, 35, 36].

In the present study, we studied the prevalence of gingivitis of the patients of age 18-20 years. However, comparable epidemiological data on gingivitis are scarce in this age group. Hence, this study has to compare with those in similar age groups. About 37 patients reported with gingivitis in the age group of 18-20 from June(2019) - March(2020) in this study. Bendoraitiene et al [37] studied periodontal status of 18yrs old patients and reported that only 22.9% of the study population had healthy periodontium. Mizutani et al [38] reported that 14.7% of his study subjects of age group 18-19 years had healthy periodontium. A study by Hessari et al [39] reported that only 8.0% of the subjects of age 18 years had healthy periodontium.

In the present study, the gingivitis was more prevalent among males than females. This is in accordance with other previous study in which females had lower plaque index and gingival index [40, 41]. This may be due to the increased concern of females towards their oral hygiene for their healthy lifestyle. In the present study plaque index and gingival index were used to evaluate the level of inflammation as it has been used widely in epidemiological studies. The mean plaque index and gingival index for the total subjects was 1.31 and 1.47 respectively, which resulted in patients of age 18-20 years having fair oral hygiene with moderate gingivitis. These findings are in accordance with Taani et al [41] who reported plaque and gingival index scores were 1.63 and 1.67 respectively in 13-14 years old school children. A study by El-Qaderi also reported similar scores in 14-16 years of school children [42].

In recent years, the prevalence and severity of dental caries have been reduced due to the use of increased fluoridated toothpastes and preventive programmes. However, periodontitis diseases remain widespread and increase with age [43]. Early diagnosis, treatment and prevention are of utmost important to prevent severe periodontal diseases at later ages. Dental plaque is the main risk factor for the development of periodontal diseases [44].

Prevention and treatment of early stage of periodontal diseases are relatively simple and effecTo remove the incidence of hormonal influenced gingivitis, all the local irritants should be removed and scrupulous plaque control measures should be carried out. Parents and patients should be educated regarding profound effects of hormones on periodontal tissues and the need of oral hygiene management [45].

Adequate daily removal of dental plaque prevents periodontal and diseases and dental caries. The most common and effective way to promote oral hygiene is tooth brushing. Hence brushing twice every day with proper brushing technique is recommended to be adopted as a habit. Fluoride in the toothpaste decreases the incidence of dental caries with frequent brushing. Most behavioural patterns were established in early childhood. It is important to establish effective dental programs for oral health and practices targeted at younger people [46].

Oral health education programmed regarding oral hygiene knowledge, practices, plaque control and gingival health should be conducted for school children and parents. Post intervention of oral health programmes showed significant improvement in oral hygiene practices among the study population [47, 48]. Epidemiological studies of periodontal status and oral hygiene are important part of such preventive programs.Our institution is passionate about high quality evidence based research and has excelled in various fields [49-59].

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Figure 1:

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Graph 1. Pie chart showing the distribution of study population with gingivitis based on age. There was a higher prevalence of gingivitis in the age of 19 years(35.14%-violet).

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Figure 2:

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Graph 2. Pie chart showing the distribution of study population with gingivitis based on gender. There was a higher prevalence of gingivitis in males(70.27%-pink) compared to females(29.73%-blue).

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Figure 3:

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Graph 3. Bar chart showing the distribution of study population with gingivitis based on gingival index according to the age. X-axis shows the age distribution and Y-axis shows the distribution of the study population based on the gingival index. There was a higher prevalence of moderate gingivitis(grey) in the age group of 18 years(21.62%) and 20 years(18.92%) and mild gingivitis(dark blue) in 19 years(18.92%). This finding was statistically significant.(Chi square test;?2=9.160, df=4, pValue= 0.057(<0.05)).

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Figure 4:

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Graph 4. Bar chart showing the distribution of study population with gingivitis based on gingival index according to the gender. X-axis shows the gender distribution and Y-axis shows the distribution of the study population based on the gingival index. There was a higher prevalence of moderate gingivitis(grey) in both males(32.43%) and females(13.51%) and however, this finding was not statistically significant.(Chi square test;?2=0.475, df=2, pValue= 0.788(>0.05)).

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Figure 5:

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Graph 5. Bar chart showing the distribution of study population with gingivitis based on plaque index according to the age. X-axis shows the age distribution and Y-axis shows the distribution of the study population based on the plaque index. There was a higher prevalence of fair oral hygiene(green) in the age group of 18-20 years, however which was not statistically significant.(Chi square test;?2=4.463, df=4, pValue= 0.347(>0.05)).

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Graph 6. Bar chart showing the distribution of study population with gingivitis based on plaque index according to the gender. X-axis shows the gender distribution and Y-axis shows the distribution of the study population based on the plaque index. There was a higher prevalence of poor oral hygiene(black) among males(13.51%) compared to the females(0%), which was however not statistically significant.(Chi square test;?2=2.851, df=2, pValue= 0.240(>0.05)).

Limitations

This study has few limitations. Since this is a retrospective study, already recorded parameters only analysed and patients with complete data only included and the study setting is also limited to certain geographical locations. Parameters such as oral hygiene practices, adverse habits and socioeconomic status were not included in this study. Hence, cohort study with the inclusion of these parameters among a large population is required for further evaluation.

Conclusion

Within the limits of this study, the prevalence of gingivitis in the age group 18-20 is high. Since the knowledge of dental diseases, methods of prevention and to maintain oral hygiene is very poor, oral health care programs should be conducted in this age group to prevent the incidence and progress of severe periodontal diseases.

Author Contributions

Oviya. V. J was the primary investigator and had a role in all aspects of this study. Along with that, Jaiganesh Ramamurthy and Deepa Gurunathan contributed equally to the structure, concept of the study and revealing of the investigation and were associated with the obtaining of study information. All Authors had access to the final report, had contributed to the analysis and discussion of the article and to have final responsibility regarding the choice to submit and affirmed the submitted adaptation.

Acknowledgement

I sincerely express my gratitude and acknowledgement to Dr.Jaiganesh Ramamurthy and Dr. Deepa Gurunathan and Dean and the management for their support and also thank the Research and IT department of Saveetha dental college for their affable assistance in analyzing the data.