Com 08

College of Dentistry
Community Dentistry
Factors Affecting the Incidence &
Prevalence of Periodontal Diseases
Dr. Hazem El Ajrami

• Factors Affecting the Incidence &
Prevalence of Periodontal Diseases:
I. Host factors.
II. Agent factors.
III. Environmental factors.

I. Host factors:
1. Age.
2. Sex.
3. Correlation with oral hygiene.
4. Association with socioeconomic status.
5. Effect of tobacco.
6. Correlation with general disease.
7. Nutritional factors.
8. Correlation with traumatic occlusion.
9. Effect of race.

1. Age:
In all surveys in which severity has been
taken into account, periodontal disease has
been found to progress steadily throughout
life. Gingivitis is common in the primary
dentition of most children, in the teenage the
prevalence of gingivitis increases with
increasing age, from age 13 upwards the
proportion of persons with periodontal
pockets increases and so the number of teeth
with bone loss.

The strong correlation between periodontal
destruction and age suggests at first glance, that
age is an etiologic factor. The explanation is
most likely that periodontal disease is a
cumulative disease and the linear increase with
age reflects this feature.
Gingivitis is also common in the mixed dentition
stage it was found to be associated with
shedding and eruption of teeth.

2. Sex:
In particularly all surveys carried out in
U.S.A. and Europe, the periodontal conditions
are found to be significantly better in females
than in males when the status of oral hygiene is
compared in the two sexes, females are found to
be considerably better than males. In less
developed countries the sex difference seems to
be absent, or reversed, i.e. the periodontal
conditions are worse in females than in males,
at least after age 20. Even when males and
females of the same oral hygiene status are
compared, the females have periodontal disease.

• The most possible explanation of this
discrepancy is that female in developing
countries give birth to many children, and that
the frequent pregnancies and lactation periods
drain the mother from nutrients. During
pregnancy, gingivitis scores increases with a
peak in its last months of pregnancy. There is
also marked increases in pocket depth. Both
these characteristics return to normal values
after delivery.

3. Correlation with oral hygiene:
The main cause of periodontal disease is the
accumulation of debris, plaque and calculus on
teeth. Those deposits can be prevented from
accumulation by oral hygiene care.

 Regardless whether gingivitis, periodontitis, or
bone destruction is measured, there is a strong
correlation between the severity of these
conditions and oral hygiene. This association
comes particularly well out when an oral
hygiene index is used.

4. Association with socioeconomic status:
Several surveys have demonstrated that the
periodontal conditions improve as the years
of formal education increases, and income
goes up. The appreciation of these simple
facts may be of value to the public health
worker when he plans how to improve
periodontal conditions on a community basis.

5. Effect of tobacco:
The effect of tobacco is consistent and
convincing, particularly the prevalence of
ulcerative gingivitis in young cigarette
smokers is dramatic but also simple gingivitis
as well as periodontitis with bone resorption
increases with increasing tobacco
consumption. This may be due to effect of the
tobacco material itself and the heat derived
during smoking.

6. Correlation with general disease:
 Epidemiological investigations have failed
to correlate a widely hold opinion from the
early days of periodontology that general
diseases, and psychiatric disorders
predisposes to periodontal disease.
 But some systemic diseases modify tissue
response to dental plaque:
A.Diabetes.
B.Leukemia.

A. DIABETES:
There is a significant correlation between
diabetes and periodontal disease especially if
the patient has poor oral hygiene.
Effect of diabetes: The increase in blood
sugar level causes atherosclerosis and
deposition of mucopolysaccharides in blood
vessels. This leads to narrowing of the blood
vessels of the gingiva decreasing the blood
supply and nutrition of the gingival tissues.

B. LEUKEMIA:
Leukaemia patients manifest gingival
bleeding, enlargement and ulcerations.

7. Nutritional factors:
Reliable statistical data regarding the effect
of nutrition on periodontal diseases are rare;
particularly the effect of various vitamins has
been in focus of interest, and for a long time
they were considered to play a very
important role. E.g. scorbutic gingivitis occur
as a result of vitamin C deficiency.

8. Correlation with traumatic occlusion:
Malocclusion is difficult to characterize in a
numerical way, and so far no fully acceptable
index has been developed. Data accumulated
up to the present time indicate that there is
some correlation between periodontal disease
and some criteria of malocclusion.

A.Crowding: Areas of crowding cause food
accumulation and present a difficulty in
maintaining good oral hygiene at those sites.
B.Protruded maxillary incisors: Causes
incompetent lips, mouth breathing which
cause dryness of gingival tissues and cracking.

9. Effect of race:
The extreme difference in prevalence and
severity of periodontal renditions in Asia and
Africa on one side and U.S.A. and
Scandinavia on the other, suggests at first
glance that a racial predisposition may be
responsible for it. Such a difference also
exists between negro and white in U.S.A.
However when education, professional
dental care and oral hygiene were kept equal,
no clear cut difference was observed.

II. Agent Factors:
The most important factor in the etiology
of diseases are bacteria, and calculus. There is
a strong positive correlation between the
amount of bacteria as expressed by the plaque
index and the degree of gingival
inflammation expressed by the gingival index
scores. Furthermore, all epidemiologic
surveys showed a strong correlation between
oral hygiene status and the severity of
periodontal destruction.

III.Environmental Factors:
1. Geographic Distribution of Periodontal
Diseases.
2. Fluoride Concentration in Drinking Water.
3. Oral Environment.

1. Geographic distribution of periodontal
diseases:
Difference in geographic distribution of
periodontal diseases can only be estimated
when the same researcher or the same research
group carry out the examination in various
places. It has been found that periodontal
diseases are much more prevalent and much
more severe in some Asian and African
countries than in U.S.A. Some South American
countries seem to fall in between these two
extremities.

2. Fluoride concentration in drinking water:
The accurate data on this point are few but
finally consistent and show that periodontal
health improves as fluoride intake increases.
However, no statistical data to this effect
have apparently been documented. The
association between fluoride concentration
and periodontal condition is mainly due to
the decrease in number of carious cavities
especially cervical and proximal.

3. Oral environment:
a) Prosthetic restoration: Several reports have
shown that gingival inflammation,
mobility and bone destruction increase in
teeth adjacent partial dentures or
orthodontic appliances. Prosthetic or
orthodontic appliances favor the
accumulation of plaque on the abutment
teeth particularly if they are improperly
designed or the patient has poor oral
hygiene.

b) Dental caries: There is positive association
between DMF scores to caries and scores for
gingivitis and periodontitis, although the
degree correlation may vary considerably.
Research data fail to substantial commonly
held opinions that there is an inverse
correlation between these two dental
diseases.

Com 08

More Related Content

What's hot (20)

Similar to Com 08 (20)

More from Lama K Banna (20)

Recently uploaded (20)

Com 08