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Indian Journal of Community Medicine

Prevalence of Periodontal Diseases in Urban and Rural areas of Ludhiana, Punjab

Author(s): GPI Singh, J. Bindra, R.K. Soni, M. Sood

Vol. 30, No. 4 (2005-10 - 2005-12)

Introduction:

Oral health is an important aspect of overall health status of an individual. Teeth and their supporting (periodontal) structures are of main importance to oral health1. Diseases of periodontium are among the most widespread diseases of mankind. Periodontium is widely affected by dental plaque - a diverse microbial community found on the tooth surface, embedded in a matrix of polymers of bacterial and salivary origin2. If not removed regularly, plaque gels mineralized to form calculus which in turn initiates the inflammatory process of PD. Initially the inflammation is confined to gingivae leading to bleeding gums. Later, other supporting structures become involved so that small pus filled packets form around teeth and there is loss of attachment. This ultimately results in tooth mobility and tooth loss3.

Materials and Methods:

This cross-sectional study was carried out in field practice areas of Department of Community Medicine, Dayanand Medical College, Ludhiana. Sample size was calculated using the formula n=4(pq/L2) where p = population proportion of positive character, q = 1-p and L = Allowable Error. For this study L was presumed to be 10% of p giving a power of (1-L) i.e. 90% to study. p was taken as 30%, the minimum known overall prevalence of some of the diseases under consideration.

Rural Health Centre covers 10 Villages with a total population of 20,002 and 3691 households. Urban Health Centre covers a population of 33,094 with 6972 households. This population is divided into five geographical areas.

A somewhat large sample than the calculation figure of 933 i.e. 1000 subjects were studied, 500 each from rural and urban areas. Each rural village and urban area was included in study with registered households serving as sampling frame. First household to be sampled was determined by lottery method and subsequent household by SRS with a sampling interval of 15 in rural villages and 30 in urban areas. All individuals in the household except those conforming to exclusion criteria were examined. In case the members of a household selected by this method were not available or non-cooperative, adjacent household was included in the sample. Exclusion criteria included children under 5 years of age, edentullous persons and subjects with partial dentition having two or more missing index teeth4 (as defined by WHO- reference no.)

All information and data were personally collected by the investigator by interview technique and oral cavity examination criteria of assessment of periodontal status as recommeded by WHO5,6 were used - oral cavities were examined for presence of calculus bleeding gums, shallow periodonatal pockets, deep periodonatal pockets and loss of tooth attachment. Only the first two were recorded in subjects below 15 years of age. Ten index teeth in oral cavity were examined for above mentioned conditions.

Training of investigator was carried out as per WHO recommedations4. She worked for one month in Deptt. of Dentistry, Dayanand Medical College and Hospital under the guidance of Head of Deptt. to learn the technique of examination of oral cavity and diagnosis of periodontal diseases. After training, consistency to apply diagnostic criteria on a group of 20 patients for two consecutive days was tested. This was repeated till a consistency of 85-95% was achieved.

Results:

96.8% urban and 97.2% rural subjects showed presence of calculus while gingival bleeding was seen in 68.6% urban and 69.2% rural subects 42.3% of urban subjects aged above 15 year showed presence of shallow periodontal pockets as compared to 31.7% of rural subjects 22.9% subjects in urban areas had deep periodontal pockets as compared to 11.0% in rural areas (Table-I). 22.9% subjects belonging to urban areas showed loss of tooth attachement as compared to 13.2% subjects belonging to rural areas (Table-II). It was found from the above data that advanced stages of PD are significantly more prevalent in urban areas as compared to rural areas.

Table -I Prevalence of Shallow and Deep Periodontal Pockets

Community Periodontal
Pocket
(4-5mm)
Present
Absent Periodontal
Pocket
(> 65)
Present
Absent Total
Urban 173 (42.3%) 193 (52.7%) 84 (22.9%) 282 (31.4%) 366 (100.0%)
Rural 118 (31.7%) 254 (68.3%) 41 (11.0%) 331 (89.0%) 372 (100.0%)
Total 291 (39.4%) 447 (60.6%) 125 (16.9%) 613 (83.1%) 738 (100.0%)

Table -II Prevalence of Loss of Tooth Attachment

Community Loss of attachment Present Absent Total
Urban 84 (22.9%) 282 (77.0%) 366 (100.0%)
Rural 49 (13.2%) 323 (86.8%) 372 (100.0%)
Total 133 (18.0%) 605 (82.0%) 738 (100.0%)

Discussion:

Earlier studies conducted in North India and Amritsar and quoted by S. Venkatesh7 show the prevalence of some forms of PD to be 60.0% and 86.6% respectively. The same author also quotes studies carried out in Trivandrum and Madras which show that 90.3% and 95.0% subjects respectively suffer from PD. The percentages in these studies are nearly the same as those of early stages of PD (Calculus and Bleeding) of present study.

95.8% dwellers of a Semi-Urban community of Poona had calculus, 62.2% had gingivities and 34.3% showed advanced periodontal involvement8. Advanced periodontal involvement included pockets >3mm and visible signs of periodontal involvement.

In yet another study carried out in Pondicherry, only 0.8% rural women had bleeding gums, 20.1% had calculus and 20.6% showed shallow periodontal pockets9.

Very few recent studies conducted in India compare prevalence of PD in urban and rural areas. SP Rao and associates carried out one such study in Sewagram10 in urban, rural and tribal school children. Bleeding, calculus and abscess were taken as prevalence criteria. It was found that there was no significant difference in prevalence of PD in urban & rural areas for the age group studied.

It is known that oral hygiene status of developed nations is better than that of people in developing countries. National Institute of Dental Research (NIDR) Survey carried out in the show prevalence of gingivities in adults was 46.9% and that of periodontal pockets ≥4 mm was 22.2%3. In another work in US, 47.0% of adult males and 39.0% adult females exhibited at least one site which bled on probing11. According to WHO, PD is one such chronic disease for which evidence is available on affecacy of prevention12. The same fact has been emphasized by other authors also1. Prevention can be achieved by effective and regular oral cleansing at personal level as well as by regular removal of calculus by trained personnel. Adverse personal habits like smoking, tobacco chewing, overeating etc should be discontinued. Health education and health promotion are indispensable in achieving this target.

References:

  1. Rozier RG. Dental Public Health. In Wallace RB ed, Public Health and Preventive Medicine, Washington; Prentice Hall International Inc 1998: 1091-1112.
  2. Marsh PD, Bradshaw DJ. Dental Plaque as a Biofilm. J Ind Microbiol 1995; 15(3): 169-175.
  3. Spolsky V. Epidemiology of Gingival and Periodontal Diseases. In: Carranza N, Dyson J eds, Clinical Periodontology, New York; WB Saunders Company, 1996 : 61-81.
  4. Oral Health Surveys Basic Methods, Geneva: World Health Organization, 1997: 11-13.
  5. Report of a WHO Scientific Group. Epidemology, Etiology and Prevention of Periodontal Diseases. Technical Report Series 621. Geneva World Health Organization, 1978.
  6. Oral Health Survey - Basic Methods Geneva: World Health Organization 1997: 25-28.
  7. Venktesh S. Oral Health in India - Current Status and Strategy. For Health Education. Swath Hind 1987: 304- 307.
  8. Singh GPI. An Epidemiological Study of Periodontal Diseases in a Semi Urban Community. MD Preventive and Social Medicine Dissertation. University of Poona 1982.
  9. Jagadeesan M. Roti SB, Danabalan M. Oral Health Status and Risk Factors for Dental & periodontal Diseases Among Rural Women In Pondicherry. Indian Journal of Community Medicine 2000: 25(1): 31-38.
  10. Rao SP, Bharambe MS. Dental Caries and Periodontal Disease among Urban. Rural and Tribal School Children. Indian Pediatrics 1993: 30(6) 759-764.
  11. Research Science and Therapy Committee of American Academy of Periodontology. Position paper on Epidemiology of Periodontal Diseases. J Periodontol 1996: 67:935-945.
  12. Ishikawa A, Kimura T, Tomozane T. Effect of Repeated Tooth brushing Instructions on Periodontal Health in a Community. Nippon-Koshu-Eisa-Zasshi 1995: 42(9): 777-782.

Deptt. of PSM, M.M.I.M.S.R., Mullana (Ambala) 133 203

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