Epidemiology of periodontal diseases

Last updated

Epidemiology of periodontal disease is the study of patterns, causes, and effects of periodontal diseases. Periodontal disease is a disease affecting the tissue surrounding the teeth. This causes the gums and the teeth to separate making spaces that become infected. The immune system tries to fight the toxins breaking down the bone and tissue connecting to the teeth to the gums. The teeth will have to be removed. This is an advance stage of gum disease that has multiple definitions. Adult periodontitis affects less than 10 to 15% of the population in industrialized countries, mainly adults around the ages of 50 to 60. The disease is now declining world-wide.

Contents

Prevalence of periodontal diseases in adults

Many studies look at the prevalence of “advanced periodontitis”, but have differing definitions of this term. Generally though, severe forms of periodontitis do not seem to affect more than 15% of the population of industrialized countries. The proportion of such subjects increases with age and seems to peak between 50 and 60 years. A later decline in prevalence may be due to tooth loss.

There are a number of methodological concerns with prevalence studies, particularly 1) the ability of partial recording to reflect full-mouth conditions and 2) the use of the Community periodontal index of treatment needs (CPITN) recording system.

The performance of a partial recording system is affected by the actual prevalence of periodontal disease in the population in question. The less frequent the disease, the more difficult it becomes for a partial recording system to detect it and thus may lead to greater underestimation of the disease prevalence. A full-mouth examination remains the best method of accurately assessing the prevalence and severity of periodontal disease in a population.

The use of the CPITN system for epidemiological purposes has flaws, which are grounded in a number of historical truths. At the time the system was designed, the initiation of periodontal disease was thought to develop from a continuum from an inflammation-free state to gingivitis, to calculus deposition and pocket formation and then to progressive disease. Treatment concepts were based on the concept of pocket depths being the most critical criterion for surgical versus non-surgical treatments. This index was also designed to screen large populations to determine treatment needs and formulate preventive strategies, not to describe the prevalence and severity of periodontal diseases.

Albandar (1999) reported on data from the Third National Health and Nutrition Examination Survey (NHANES III). [1] This was derived from a large nationally representative, stratified, multistage probability sample in the USA comprising 9689 subjects. Pockets > 5mm were found in 7.6% of non-Hispanic white subjects, 18.4% of non-Hispanic black subjects and 14.4% in Mexican Americans; a total of 8.9% of all subjects had pockets > 5mm. Attachment loss > 5mm was found in 19.9% of non-Hispanic white subjects, 27.9% of non-Hispanic black subjects and 28.3% of Mexican Americans; a total of 19.9% of all subjects had attachment loss > 5mm. This suggests that severe periodontitis in not uniformly distributed among various races, ethnicities and socioeconomic groups.

Hugoson (1998) examined three random samples of 600, 597 and 584 subjects in 1973, 1983 and 1993 respectively. These subjects were aged 20–70 years. The severity of disease was divided into five groups, with group 5 having the most severe disease. There was an apparent increase from 1% to 2% to 3% over the three study periods, which may have been due to an increase of dentate subjects in the older age groups. [2]

Susin 2004 examined a representative sample of 853 dentate individuals in Brazil who were selected by a multistage probability sampling method. They had a full-mouth clinical examination of six sites per tooth and answered a structured written questionnaire. Seventy-nine percent (79%) and 52% of the subjects and 36% and 16% of the teeth per subject had CAL >5 and >7mm, respectively.[ citation needed ]

Oliver 1998[ citation needed ]

Bourgeois 2007 found that the prevalence of deep pockets (> 5mm) is low (10.21%) in a cross-sectional study.[ citation needed ]

Baelum 1996 recalculated their previous data from Kenyan and Chinese populations to conform to the methods of examination and data presentation utilized in six other surveys. They did not find that the data supported the traditional generalization that prevalence and severity of periodontitis is markedly increased in African and Asian populations.[ citation needed ]

Incidence of periodontitis

Like measurements of prevalence of periodontitis, the measurement of incidence will vary depending upon the case definition of the disease. Often “incidence” refers to new sites that meet the definition of periodontitis, even if they occur within a person that already has other diseased sites.[ citation needed ]

Beck 1997 found that past disease predicted subsequent CAL, although not usually at the same site. Also, persons with greater attachment loss at baseline were more likely to lose teeth over the next 5 years.[ citation needed ]

Beck 1997 – looked at incidence density such that the numerator was attachment loss greater or equal to 3mm while the denominator was the time at risk for each site. The incident density for all subjects was 0.0017 per site per month. In other words, if 1000 sites were followed for one month, 1.7 sites would lose 3mm or greater attachment. In one year, 20.6 sites would be expected to show this degree of loss.[ citation needed ] - blacks has twice the incidence density of whites; males > females.[ citation needed ]

Gilbert 2005 describes a prospective study of persons in Florida > 45 years old. In-person interviews and examinations were conducted at baseline and 48 months. The study size was 560 persons and at the 48-month examination, 22% of persons and 1.8% of teeth had attachment loss incidence.[ citation needed ]

Early onset periodontitis

Albandar 2002 examined 690 school attendees aged 12–25 years. They found that 2.3% had generalized EOP and 4.2% had localized EOP. This total of 6.5% contrasted with 1.8% for Nigeria, 3.1–3.7% for Brazil, 6.8% in India and 8% in Sudan. The prevalence in Caucasian populations is in the 0.1% to 0.2% range and may indicate that subjects originating from the sub-Saharan countries of Africa may be at higher risk of developing EOP.[ citation needed ]

Tinoco 1997 examined 7843 children between the ages of 12 to 19 in Brazil with strict clinical and radiographic criteria. A 0.3% prevalence of localized juvenile periodontitis was found, with different subpopulations exhibiting a range between 0.1% to 1.1%. This study found that LJP was highly associated with Actinobacillus actinomycetemcomitans.[ citation needed ]

Lopez 2001 examined 9,162 high school children for clinical attachment loss in 6 sites of first and second molars and incisors. Overall, CAL >1mm was seen in 69.2% of the students; >2mm in 16% of the students and >3mm in 4.5%. They noted that while the distribution of CAL was markedly skewed, it followed a continuum of disease severity. No sharp distinction exists between periodontal health and disease among Chilean adolescents.[ citation needed ]

Levin 2006 studied 642 young Israeli army recruits (562 men and 80 women) – clinical periodontal examination of four first molars and eight incisors and radiographs were completed. Aggressive periodontitis was found in 5.9% of the subjects (4.3% localized and 1.6% generalized). This was significantly associated with current smoking and ethnic origin (North African).[ citation needed ]

Eres 2009 examined 3,056 students between the ages of 13 to 19 years at public schools in Turkey. Their mouths were coded according to the recommendations of the CPITN (Community Periodontal Index of Treatment Needs). Among the 3,056 students screened, 170 were scheduled for further examination and 18 were diagnosed with localized aggressive periodontitis. Thus, the prevalence of LAgP was 0.6% with a female to male ratio of 1.25:1.[ citation needed ]

Tooth loss

Baelum 1997 reported on the incidence of tooth loss over 10 years among adult and elderly Chinese and looked at some predictive factors. There were 440 subjects, 8 of which were edentulous at baseline and 31 who lost all remaining teeth during the study period. Of the 401 who remained dentate, the incidence of tooth loss ranged from 45% in the 20- to 29-year-old group to 96% in the 60 years plus group. He found that the best baseline predictors of tooth loss of all remaining teeth was that at least one tooth had attachment loss greater or equal to 7mm. As in other studies, a major portion of the total number of teeth lost was accounted for by a small group of persons. In this study, dental caries was the dominant reason for tooth loss.

Related Research Articles

Periodontal disease

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen, red, and may bleed. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.

Calculus (dental)

In dentistry, calculus or tartar is a form of hardened dental plaque. It is caused by precipitation of minerals from saliva and gingival crevicular fluid (GCF) in plaque on the teeth. This process of precipitation kills the bacterial cells within dental plaque, but the rough and hardened surface that is formed provides an ideal surface for further plaque formation. This leads to calculus buildup, which compromises the health of the gingiva (gums). Calculus can form both along the gumline, where it is referred to as supragingival, and within the narrow sulcus that exists between the teeth and the gingiva, where it is referred to as subgingival.

Acute necrotizing ulcerative gingivitis Common, non-contagious infection of the gums with sudden onset

Acute necrotizing ulcerative gingivitis (ANUG) is a common, non-contagious infection of the gums with sudden onset. The main features are painful, bleeding gums, and ulceration of inter-dental papillae. This disease, along with necrotizing (ulcerative) periodontitis is classified as a necrotizing periodontal disease, one of the seven general types of gum disease caused by inflammation of the gums (periodontitis).

Periodontal fiber group of specialized connective tissue fibers

The periodontal ligament, commonly abbreviated as the PDL, is a group of specialized connective tissue fibers that essentially attach a tooth to the alveolar bone within which it sits. It inserts into root cementum one side and onto alveolar bone on the other.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

Dental plaque is a biofilm of microorganisms that grows on surfaces within the mouth. It is a sticky colorless deposit at first, but when it forms tartar, it is often brown or pale yellow. It is commonly found between the teeth, on the front of teeth, behind teeth, on chewing surfaces, along the gumline, (supragingival) or below the gumline cervical margins (subgingival). Dental plaque is also known as microbial plaque, oral biofilm, dental biofilm, dental plaque biofilm or bacterial plaque biofilm. Bacterial plaque is one of the major causes for dental decay and gum disease.

Tooth loss is a process in which one or more teeth come loose and fall out. Tooth loss is normal for deciduous teeth, when they are replaced by a person's adult teeth. Otherwise, losing teeth is undesirable and is the result of injury or disease, such as dental avulsion, tooth decay, and gum disease. The condition of being toothless or missing one or more teeth is called edentulism.

Scaling and root planing

Scaling and root planing, also known as conventional periodontal therapy, non-surgical periodontal therapy or deep cleaning, is a procedure involving removal of dental plaque and calculus and then smoothing, or planing, of the (exposed) surfaces of the roots, removing cementum or dentine that is impregnated with calculus, toxins, or microorganisms, the etiologic agents that cause inflammation. It is a part of non-surgical periodontal therapy. This helps to establish a periodontium that is in remission of periodontal disease. Periodontal scalers and periodontal curettes are some of the tools involved.

Gingivectomy is a dental procedure in which a dentist or oral surgeon cuts away part of the gums in the mouth.

Oral hygiene Cleaning the mouth by brushing the teeth and cleaning in between the teeth.

Oral hygiene is the practice of keeping one's mouth clean and free of disease and other problems by regular brushing of the teeth and cleaning between the teeth. It is important that oral hygiene be carried out on a regular basis to enable prevention of dental disease and bad breath. The most common types of dental disease are tooth decay and gum diseases, including gingivitis, and periodontitis.

Laser-assisted new attachment procedure (LANAP) is a surgical therapy for the treatment of periodontitis, intended to work through regeneration rather than resection. This therapy and the laser used to perform it have been in use since 1994. It was developed by Robert H. Gregg II and Delwin McCarthy.

Gingivitis Inflammation of the gums

Gingivitis is a non-destructive disease that causes inflammation of the gums. The most common form of gingivitis, and the most common form of periodontal disease overall, is in response to bacterial biofilms that is attached to tooth surfaces, termed plaque-induced gingivitis. Most forms of gingivitis are plaque-induced.

Periodontitis as a manifestation of systemic diseases is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system and is one of the three classifications of periodontal diseases and conditions within the 2017 classification. At least 16 systemic diseases have been linked to periodontitis. These systemic diseases are associated with periodontal disease because they generally contribute to either a decreased host resistance to infections or dysfunction in the connective tissue of the gums, increasing patient susceptibility to inflammation-induced destruction.
These secondary periodontal inflammations should not be confused by other conditions in which an epidemiological association with periodontitis was revealed, but no causative connection was proved yet. Such conditions are coronary heart diseases, cerebrovascular diseases and erectile dysfunction.

Combined periodontic-endodontic lesions are localized, circumscribed areas of bacterial infection originating from either dental pulp, periodontal tissues surrounding the involved tooth or teeth or both.

Chronic periodontitis is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by the accumulation of profuse amounts of dental plaque. Periodontitis initially begins as gingivitis and can progress onto chronic and subsequent aggressive periodontitis according to the 1999 classification.

Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis as defined by the 1999 classification system:

  1. Localized aggressive periodontitis (LAP)
  2. Generalized aggressive periodontitis (GAP)

In dentistry, numerous types of classification schemes have been developed to describe the teeth and gum tissue in a way that categorizes various defects. All of these classification schemes combine to provide the periodontal diagnosis of the aforementioned tissues in their various states of health and disease.

Tooth mobility

Tooth mobility is the horizontal or vertical displacement of a tooth beyond its normal physiological boundaries around the gingival area, i.e. the medical term for a loose tooth.

Tooth ankylosis is the pathological fusion between alveolar bone and the cementum of teeth, which is a rare phenomenon in the deciduous dentition and even more uncommon in permanent teeth. Ankylosis occurs when partial root resorption is followed by repair with either cementum or dentine that unites the tooth root with the alveolar bone, usually after trauma. However, root resorption does not necessarily lead to tooth ankylosis and the causes of tooth ankylosis remain uncertain to a large extent. However, it is evident that the incident rate of ankylosis in deciduous teeth is much higher than that of permanent teeth.

References

  1. Albandar, Brunelle & Kingman 1999.
  2. Hugoson et al. 1998.

Further reading