Evaluation of Oral Hygiene Status in Patients with Shallow Vestibular Depth in A Hospital Setting - A Retrospective Analysis

Keywords

Oral Health; Oral Hygiene; Periodontal; Shallow Vestibular Depth.

Introduction

Oral health is considered as the quality of health that enables an individual to socialize easily without any active disease, discomfort or embarrassment which impacts general well being [1]. One of the major public health problems is oral diseases, which has higher prevalence and significant social impact [2]. To improve on oral health in the community, it is essential to have oral health related knowledge. Good oral hygiene has shown to contribute greatly to the prevention of oral diseases [2, 3].

Periodontal practice not only emphasizes biological and functional problems that affect the periodontium but also focuses on improving aesthetic appearance due to recent advances on periodontal therapy [3]. Gingival recession is defined as exposure of the root surface by the apical migration of junctional epithelium which causes poor aesthetic appearance, root hypersensitivity and root caries [4]. Shallow vestibule along with inadequate width of attached gingiva is a common cause of gingival recession and it is a very common clinical finding in the front region of the lower jaw [5].

Shallow vestibule, gingival recession, and aberrant frenum which causes mucogingival problems, several independent and effective surgical procedures have been developed. The depth of vestibule and the width of the attached gingiva can be increased in a single visit by vestibular deepening procedure [6]. The vestibular depth is defined either as the distance between the crest of the lip and greatest concavity of the mucobuccal fold or the distance between the corional border of the attached gingiva and the mucobuccal fold could be measured [7].

The term mucogingival surgeries were introduced by Freidman and Levin in 1957, to describe the surgical procedure that corrects the relationship between the gingival and oral mucous membrane such as attached gingiva, shallow vestibule, and aberrant frenum [8]. In 1953, Goldman emphasized that a shallow vestibule leads to food impaction against the gingival margin and into the interproximal spaces, which makes it difficult for the patient to clean the area [9]. However, the aim of this study is to evaluate the oral hygiene status in patients with shallow depth.

Materials and Methods

Study Setting and Sampling

This study is a single- centred retrospective study, carried out in a private dental college. The present study was approved by Institutional ethical committee [IEC] (Ethical approval number: SDC/ SIHEC/2020/DIASDATA/0619-0320) and was in accordance with the ethical standards that were stipulated. All available records of patients with shallow vestibular depth from June 2019 - April 2020 were examined and included in our data collection. A total of 86000 case sheets were reviewed. Cross verification of data for error was done by presence of additional reviewers and by photographic evaluation. Two examiners were involved in the study.

Data Collection

Acquisition of data was done from the hospital database which records all patient details. The study included 15 patients with shallow vestibular depth. The collected data were grouped based on the presence of shallow vestibular depth. Gender was categorised into males and females and age was categorised into 18-35 years, 36-55 years and >55 years. The data were entered in the system in a methodical manner. For this study, data regarding age, gender and the oral hygiene index- simplified interpretation were collected. The data was then entered in excel manually and imported to SPSS for analysis. Incomplete or censored data were excluded from the study.

Statistical Analysis

The statistical analysis was done using SPSS software (SPSS version 21.0, SPSS, Chicago II, USA). Descriptive statistics was used to summarise the demographic information of the patients included in this study. Descriptive statistics is used for the acquisition of frequency distribution of the data. Chi-square test was applied to analyse the association of different variables. Statistical significance was kept at p<0.05.

Results and Discussion

In the present study, based on the age wise distribution of study population, 50% of patients were found in the age group of 36- 55 years, 28.5% of the population was found in the age group of >55 years and 21.4% of the population was found in the age group of 18-35 years with shallow vestibular depth (Figure 1). Based on the gender wise distribution of study population, females (64.2%) dominated the study population than males (35.7%) (Figure 2). Based on the OHI-S score of the study population, the oral hygiene status was found to be fair in 57.1% of the patients, good in 24.3% of the patients and poor in 24.3% of the patients (Figure 3).

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Figure 1:

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Figure 1. Bar chart represents the distribution of the study population by age. The X axis denotes the age group of the patients and the Y axis denotes the percentage of patients with shallow vestibular depth. From the graph, it is observed that the majority of the patients were in the age group of 36 - 55 years (50%).

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Figure 2:

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Figure 2. Bar chart represents the distribution of the patients based on gender. The X axis denotes the gender of the patients and the Y axis denotes the percentage of patients with shallow vestibular depth. From the graph, it is observed that the majority of the patients were females (64.2%) when compared to males (35.7%).

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Figure 3:

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Figure 3. Bar chart represents the OHI-S score of the study population.. The X axis denotes the OHI-S interpretation and Y axis denotes the number of patients with shallow vestibular depth. From the graph, it is observed that the majority of the patients were found to have fair (57.1%) oral hygiene status.

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Based on the association of age and OHI-S, 14% of the patients had good, 28% of the patients had fair and 7% of the patients had poor oral hygiene status in the age group between 18-35 years and 7% of the patients had good, 28% of the patients had fair and 7% of the patients had poor oral hygiene status in the age group between 36-55 years. (Figure 4)

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Figure 4:

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Figure 4. Bar chart represents the association between the age group and OHI-S interpretation. X axis denotes the age group of the patients and Y axis denotes the number.The oral hygiene status was found to be fair in the age group between 36-55 years (green;42.8%) and patients over 55 years of age showed poor oral hygiene(beige). However, it is statistically not significant. (Chi-square test, p value- 0.068 ( P > 0.05 )).

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Based on the association of gender and OHI-S, 7% of the patients had good, 21% of the patients had fair and 7% of the patients had poor oral hygiene status among males and 14% of the patients had good, 36% of the patients had fair and 14% of the patients had poor oral hygiene status among females (Figure 5).

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Figure 5:

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Figure 5. Bar chart represents the association between the gender and OHI-S. X axis denotes the gender of the patients and the Y axis denotes the number of patients with shallow vestibular depth. The oral hygiene status was found to be fair in the majority of the female patients (green ;35.7%) when compared to male patients. However, it is statistically not significant. (Chi-square test, p value- 0.987 ( P > 0.05).

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Table 1:

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Table 1. Frequency distribution of oral hygiene status in patients with shallow vestibular depth.

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Several studies indicated that the role of adequate width of attached gingiva is very important for the maintenance of oral hygiene. Shallow vestibule may occur without any symptoms, but this may explore the patient due to unesthetics appearance, difficulty to perform plaque control procedures, dentinal hypersensitivity, etc.,[1] Several studies indicated that the role of adequate depth of vestibule is very important for the maintenance of oral hygiene. Wennstrom and PiniPrato reported that combination of the shallow vestibule and inadequate width of attached gingiva might favor the food accumulation during mastication and difficulty to maintain the oral hygiene [10].

The prevalence of Shallow vestibular depth in this study was found in 50% of the population in both the age groups of 18 - 35 years and 36-55 years. This prevalence is compared with studies mentioned in a review paper and found to be lower than Vietnamese (72.5%), France (84%) and higher than Malaysia (28.6%), Sweden (44%) and India (24.29%) [1, 11]. However the age group was not exactly the same in all these studies. But a research study on Indian population reported a significant association of width of attached gingiva on oral hygiene index [12]. Wade reported that adequate width of attached gingiva is a common requirement for root coverage and suggested vestibular deepening is an effective technique for gaining the width of the attached gingiva and avoiding gingival recession [13].

But it is commonly observed that gingival recession due to shallow vestibular depth is not much in young adults, but it increases with age [14]. In the present study, the oral hygiene status was found to be fair in the majority of the female patients. This is in contrast to the results which reported in Indian, American and Turkey studies [15, 16] and is attributed due to less frequency of dental visits, poor oral hygiene and smoking habit in males than females. The mean vestibular depth, measured from the marginal gingiva to mucobuccal fold, was 9.21 mm. In patients with gingival recession either adjacent marginal gingiva level was considered. Ward VJ reported a vestibular depth range of 2.5 mm to 11.5 mm using radiographic technique [17]. The techniques to deepen the vestibule in edentulous patients was primarily introduced in 1924 by Kazanjian. Goldman et al introduced the rationale and techniques of mucogingival surgery in 1956 [18].

In a study, 20-40-year-old age group of subjects were included because their permanent dentition was relatively complete and the occurrence of gingival recession and shallow vestibular depth had previously been detected in this age group and can be implied mostly to predisposing factors than chronic periodontal diseases [19]. Previously our team had conducted numerous clinical trials [20-24] and lab studies [25-29] and in vitro studies [30-34] over the past 5 years. Smaller sample size could have impacted the results. For appropriate results, cohort study or community based studies should be done on a larger sample size for the assessment of the oral hygiene status in patients with shallow vestibular depth.

Conclusion

To conclude, within the limitations of the present study, female patients and patients in the age group of 35- 55 years were comparatively more in the study population. The study showed no significant association of oral hygiene with age and gender in presence of shallow vestibular depth. Until now, the management of shallow vestibule has largely been considered important only when replacing it with a removable prosthetic system for retentive purposes. The present study revealed that in patients with shallow vestibular depth, fair oral hygiene status was more commonly observed emphasizing the need for preventive therapeutic measures to correct the shallow vestibule, thereby improving the oral health.

Acknowledgement

This research was supported by saveetha dental college and hospital. We thank the department of Periodontics, Saveetha Dental College for providing insight and expertise that greatly assisted this research.

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