Prevalence Of Periodontitis Among Different Age Groups: A Retrospective Study

Keywords

Bacterial Plaque; Gingivitis; Periodontitis; Inflammation.

Introduction

Periodontitis, a chronic infectious disease, affects most of the population at one time or the other and its expression is a combination of hosts, microbial agents, and environmental factors [1].

It does not appear to be a single disease with variations in clinical symptoms, but a group of diseases with overlapping symptomatology [2]. Etiology is however complex with many factors at risk, of which, few are biological such as age, systemic conditions, and others are behavioral factors such as smoking and oral cleanliness [2, 3].

Periodontal disease is a group of lesions affecting the tissues surrounding and supporting teeth [5]. Majority of diseases of periodontium can be classified as either gingivitis or periodontitis or periodontitis as a manifestation of systemic disease [6]. The primary etiology of periodontal disease is bacterial plaque. However the disease is modified by a variety of risk factors like age, gender, stress, malnutrition, smoking, systemic disease, genetic factors [7]. Age is one of the risk determinants of periodontal disease [8]. Aging is a complex multifactorial process that increases susceptibility to chronic inflammatory diseases and microbial infections, such as periodontitis. Older individuals have higher levels of some Gram-negative bacilli, such as Pseudomonas aeruginosa, Klebsiella pneumonia, and Enterobacter, as compared with young individuals [4]. However, relatively little is known on how aging affects oral bacterial communities [5]. Also differences in demographic characteristics and levels of exposure to various risk factors among different populations can partially explain the wide range in the prevalence of periodontal disease, but their variance can also be a result of differences in periodontal examination protocol [4, 6]. Epidemiological studies on prevalence of periodontitis helps in implementation and planning of oral health programs.

Previously our team has a rich experience in working on various research projects across multiple disciplines [7-21]. This study aims to assess the prevalence of periodontitis among different age groups.

Materials And Methods

This retrospective study was conducted among periodontitis patients above 18 years who visited a private dental college in chennai from June 2019 to March 2020. Prior permission to utilise the data for the analysis was obtained from the Institution Ethics Board with the ethical approval number being: SDC/ SIHEC/2020/DIASDATA/0619-0320. Study participants were divided based on the age as follows: 18-25 years, 26-35 years, 36- 45 years, 46-55 years 56-65 years and 66-75 years.

A total of 640 periodontitis patients above 18 years were randomly recruited. Consecutive sampling method was carried out. Cross verification of data was done via photographs, data evaluation was done with two reviewers and cross verified with third reviewer. Relevant data such as age and gender were recorded. Patients with systemic illness, those with a habit of smoking and those who were on long term medications were excluded from the study. Repeated and incomplete data records were excluded. Data was verified by an external reviewer. Data regarding the periodontal status of the patients were collected from the case records and analysed.

Data was retrieved and entered in Microsoft Excel sheet and later exported to SPSS software (Version 23.0) for statistical analysis. Descriptive (frequency distribution and percentage) and inferential statistics (chi-square test) were done using SPSS software. Level of significance was set as p< 0.05 for this study.

Results And Discussion

In the present study, among 640 periodontitis patients, 536 patients had generalised periodontitis (83.75%) and 104 patients had localised periodontitis (16.25%) [Figure 1].

The study participants were divided based on the age as follows: 18-25 years, 26-35 years, 36-45 years, 46-55 years, 56-65 years and 66-75 years. The prevalence of generalised periodontitis was higher among the age group of 36-45 year old patients (25.7%) followed by 26-35 year old patients (23.4%), followed by 46-55 year old patients (16.5%), followed by 18-25 year old patients (8.1%), followed by 56-65 year old patients (7.6%) and 65-75 year old patients (2.1%).

The prevalence of localised periodontitis was higher among the age group of 26-35 year old patients (5.6%) followed by 36-45 year old patients (4.2%), followed by 46-55 year old patients (3.1%), followed by 18-25 year old patients (1.8%), followed by 56-65 year old patients (0.78%) and 65-75 year old patients (0.63%). The association between age and periodontitis was analysed using chisquare test and was found to be statistically not significant with the p value of 0.452 [Figure 2].

Out of 640 periodontitis patients, there were 385 males and 255 females. The type of periodontitis was assessed based on the gender. Generalised periodontitis was prevalent among 323 males (50.4%) and 213 females (33.2%). Localised periodontitis was prevalent among 62 males (9.6%) and 42 females (6.5%). Both generalised and localised periodontitis show a male predominance. The association between gender and the periodontitis was analysed using chi-square test and was found to be statistically insignificant with the p value of 0.493 [Figure 3].

In the current study participants were classified into age groups 18-25 years, 26- 35 years, 36-45 years, 46-55 years, 56-65 years, 66- 75 years. This is in accordance with study by Akbar and partiwi et al, reported age can be classified into seven groups namely early adolescence (12-16 years), late adolescence (17-25 years), young adults (26-35 years), late Adults (36-45 years), early elderly (46-55 years), late elderly (56-65 years) and senior > 65 years. Prevalent age groups with periodontitis were found to be between 26-45 years [22]. This is contradictory to finding that prevalence and severity of periodontal disease tends to increase with patient age [23-25]. Another contradictory findings showed that chronic periodontitis occurred frequently in all age groups with an increasing percentage in the older age (56%), (74%) in adults and (80%) in elderly [26]. Bokhari et al reported that subjects aged 40 years and above were four times more likely to have periodontitis [27]. Increased prevalence in aging attributed that with aging, oral epithelial cells have reduced mitotic activity and metabolic rate [28].

General deterioration in immune functions and tissue integrity in the older age group serve as a hypothesis for the weakness of periodontal disease. In the current study no significant correlation with prevalence of periodontitis with age group was observed. Contradictory to findings by Bhadbhade et al shows significant correlation between periodontal disease and age group [29]. Current knowledge has shown that periodontitis does not present a linear progression and is not age dependent. Moreover, its distribution and severity are strongly influenced by host susceptibility and risk factors. Several epidemiological studies evaluating destructive periodontal diseases have been pursuing associations in the incessant identification of risk factors for these diseases. Analytical epidemiology seeks to identify the risk factors associated with a disease, to quantify the strength of those associations and to estimate whether an association is causal [30]. An understanding of risk factors can lead to theories of causation and then to treatment protocols for clinicians to use in their daily practice. In the present study, periodontitis was prevalent among males when compared to females. This is in accordance with studies done by Doifode et al, Kundu et al, and Sekhon et al which have concluded that periodontal disease was more common in males, with the explanation put forward being the deleterious oral habits which are more prevalent in male population [25].Our institution is passionate about high quality evidence based research and has excelled in various fields [26-36].

The limitations of the present study includes limited sample size and similar ethnicity. Therefore, multicenter studies need to be conducted among larger populations to confirm this finding. Within the limitations, the present study showed that generalised periodontitis (25.78%) was more prevalent in the age group of 36-45 years and localised periodontitis (5.63%).

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Figure 1:

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Figure 1: Bar graph depicting the distribution of type of periodontitis among the study population. X axis represents type of periodontitis and Y axis represents the number of patients. The more prevalent periodontal disease is generalized periodontitis (Green) which constitutes to 83.75% when compared to localized periodontitis (Orange) which constitutes to 16.25%.

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Figure 2:

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Figure 2: This bar graph shows association between different age groups and periodontitis. X axis represents age groups and Y axis represents the number of periodontitis patients. Generalised periodontitis (Green) was prevalent among the 36- 45 year old patients (25.78%) and Localized periodontitis was most prevalent among the 26-35 year old patients (5.63%). The association between different age groups and periodontitis was statistically not significant (Chi-square analysis, p=0.452).

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Figure 3:

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Figure 3: This bar graph shows association between gender and periodontitis. X axis represents gender and Y axis represents the number of periodontitis patients. Both generalised (50.47%) and localised (9.69%) periodontitis showed a male predominance. The association between gender and periodontitis was statistically not significant (Chi-square analysis, p=0.493).

Conclusion

Within the limits of the study, it can be observed that generalised periodontitis (25.78%) was more prevalent in the age group of 36-45 years and localised periodontitis (5.63%). Both generalised and localised periodontitis showed a male predilection.

Acknowledgement

The authors of this study would like to express their gratitude towards everyone who facilitated and enabled us to carry out this study successfully. We would also thank the institute for helping us to have access to all the case records for collecting the required cases for conducting this study.