EPIDEMIOLOGY OF PERIODONTAL

DISEASE

3rd year postgraduate Public health dentistry

INTRODUCTIONThe periodontium, defined as those tissues

supporting and investing the tooth,comprises of

CementumPdlAlveolar bone Dentogingival junction

EPIDEMIOLOGY Epi = upon

Demos = people

Ology = science

Epidemiology = the science which deals with what falls upon

people…..

Epidemiology has been defined by John M. last in 1988

as:-‘The study of the distribution and determinants of health-

related states or events in specified populations and the

application of this study to the control of health problems.’

CLASSIFICATION OF EPIDEMIOLOGY

It can be classified into 2 types :- [1] observational studies [2] Experimental or intervention • Descriptive studies studies

• Analytical studies – {a} randomized controlled trials

{a} ecological or correlational or clinical trials

{b} cross-sectional or prevalence {b} field trials

{c} case – control or case- reference {c} community trials or community

{d} cohort or follow-up intervention studies

PERIODONTAL DISEASE Periodontal disease is a term which includes all

pathological conditions of the periodontium

(gingiva, alveolar bone, cementum and periodontal

ligament).

Traditionally periodontal disease were classified

into gingival diseases and periodontal diseases.

EPIDEMIOLOGICAL TRIAD

[1] HOST FACTORS

[2] AGENT FACTORS

[3] ENVIRONMENTAL FACTORS

HOST FACTORS

1. AGE - More with older age groups (40 YEARS)

2. SEX – More in males

3. RACE – Blacks are more affected than whites

HOST FACTORS

4. INTRAORAL VARIATIONS- Gingivitis is more seen

on the interproximal areas than buccal and lingual.

5. SEVERITY OF BONE LOSS – incisor and molar

areas are more severely involved than canine and

premolars.

Maxillary teeth experience more bone loss compared

to mandible.

HOST FACTORS6. ENDOCRINE CHANGES – chances are more in puberty, menstruation and pregnancy, hyper – thyroidism, hyper – parathyroidism.7. TRAUMATIC OCCLUSION – sharp cusp acts as plungers and lead to periodontitis.9. TOOTH POSITION – irregular alignment unclean areas

pocket formation

HOST FACTORS

10. OCCUPATIONAL HABITS – thread biting, holding

nails between teeth etc.

11.NEUROSIS – bruxism, lip, cheek and nail biting

12. USE OF TOBACCO – components present in tobacco

lower the tissue resistance

HOST FACTORS

13. MISUSE OF TOOTHBRUSH

14. CONCOMITANT DISEASE – there is tendency towards

alveolar bone destruction in patients with uncontrolled diabetes.

15. INCOME – pdl diseases increases with decrease in income

16. EDUCATION – pdl diseases and education is also

inversely related

AGENT FACTORS[A] PLAQUE[B] CALCULUS

DENTAL PLAQUE

Primary etiologic factor for PDL disease.

It is defined as soft deposits that form the bio – film

adhering to the tooth surface or other hard surfaces in the

oral cavity including removable and fixed dentures.

Disruption of balance between plaque bacteria and host

results in PDL diseases.

Dental plaque is divided into : - [1] supragingival

[2] subgingival

DENTAL PLAQUE

Marginal plaque responsible for –gingivitis

Supragingival and tooth associated subgingival plaque –

calculus and root caries

Tissue associated subgingival plaque – periodontitis

1 gram of plaque contains 2 ×10¹¹ bacteria

It also contains epithelial cells and macrophages

embedded in an organic and inorganic matrix.

DENTAL PLAQUE

Organic and inorganic materials are derived from

bacterial products.

Accumulation of plaque is found to be more on gingival

1/3rd of the tooth surface, cracks, pits and fissures,

overhanging restorations and around mal-aligned teeth.

The rate of formation and location vary according to the

oral hygiene practices, diet, salivary composition and

rate of flow.

DENTAL CALCULUS

Calculus is an adherent calcified mass that forms on the

surface of natural teeth and dental prosthesis.

It consists of mineralized plaque.

Calculus would be divided into :- [1] supragingival

[2] subgingival

SUPRAGINGIVAL CALCULUS

It is white or whitish yellow in color.

It is found to be maximum in the upper 1st molars,

followed by the lower central and laterals and least in

upper anteriors.

It can be easily detached.

SUBGINGIVAL CALCULUS

It is dark brown or greenish black in color.

It is found to be maximum in lower centrals and laterals

and followed by upper 1st molar, upper anteriors and

upper 2nd molars.

It is found to be least in lower 1st and 2nd premolars and

lower 3rd molars.

ENVIRONMENTAL FACTORS

[1] GEOGRAPHIC VARIATIONS – high in Chile,

Jordan, India, Malasiya, Ceylon; intermediate in

US(blacks), Columbia, Ethiopia and Ecuador and low in

US (whites), dentist deprived areas.

ENVIRONMENTAL FACTORS

[2] NUTRITION – high in Niacin deficiency and

Avitaminosis C.

ICNND (International Committee On Nutrition for

National Defence) said that there is no consistent

association between periodontal diseases and nutrition

items.

ENVIRONMENTAL FACTORS

Severity of periodontal diseases were found in areas with

protein energy malnutrition and vitamin A deficiency.

[3] DEGREE OF URBANIZATION – rural population

seems to suffer more from periodontal diseases compared to

urban population.

.

ENVIRONMENTAL FACTORS

[4] STRESS- is said to predispose to ANUG and is often

seen in exam going students.

CONCLUSION

Periodontal disease accounts for a majority of

missing teeth in adults and result in tremendous

economic and social burdens both to the individual

and society.

Periodontal disease is so prevalent that the only

possible solution is the “prevention”

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