Periodontal disease among indigenous people in the Amazon rain forest

The Bioarchaeology of Health Crisis: Infectious Disease in the Past

Beginning some 10,000 years ago, humans began a dramatic alteration in living conditions relating especially to the shift in lifeway from foraging to farming. In addition to the initiation of and increasing focus on the production and consumption of domesticated plant carbohydrates, this revolutionary transformation in diet occasioned a decline in mobility and an increased size and agglomeration of populations in semipermanent or permanent settlements. These changes in life conditions presented an opportunity for increased transmission of pathogenic microbes from host to host, such as those that cause major health threats affecting most of the 7.5 billion members of our species today. This article discusses the bioarchaeology of infectious disease, focusing on tuberculosis, treponematosis, dental caries, and periodontitis, all of which continue to contribute to high levels of morbidity and mortality among the world's populations today.

Self-report of gingival problems and periodontitis in indigenous and non-indigenous populations in Chiapas, Mexico

OBJECTIVE

To estimate the prevalence of self-reported gingival and periodontal conditions and their association with smoking, oral hygiene, indigenous origin, diabetes and location (urban or rural) in indigenous and non-indigenous adults in Chiapas, Mexico.

METHODS

A cross-sectional study of 1,749 persons, ≥20 years of age, living in four rural and four urban marginal localities in Comitán (Chiapas, México). The variables investigated were: age; sex; indigenous origin; oral hygiene; halitosis; chewing ability; gingival conditions; periodontitis; smoking; alcoholism; diabetes; and location. Bivariate analysis and a logistic regression model were used to identify the association of periodontitis with the independent variables.

RESULTS

In total, 762 (43.6%) indigenous and 987 (56.4%) non-indigenous persons were interviewed. Their mean age was 41 ± 14 years, 66.7% were women and 43.8% lived in rural locations. Gingival problems were reported by 68.5% and periodontitis by 8.7%. In total, 17.9% had used dental services during the previous year, 28.7% wore a removable partial or a complete dental prosthesis, 63.7% had lost at least one tooth, the prevalence of diabetes was 9.2% and the prevalence of smoking was 12.2%. The logistic regression model showed that age, diabetes and the interaction between rural location and indigenous origin were associated with the presence of periodontitis.

CONCLUSIONS

Indigenous people living in rural areas are more likely to have periodontitis. It is necessary to promote oral health practices in indigenous and marginalised populations with a focus on community-oriented primary care.

Epidemiology of oral health conditions in older people

The main conditions of interest when considering the epidemiology of oral diseases among older people are tooth loss, dental caries, periodontitis, dry mouth and oral pre-cancer/cancer, along with oral-health-related quality of life (OHRQoL). This article presents an overview of what is known about the epidemiology of each of the main conditions of interest among older populations.

Destructive periodontal disease in adult Indians from Northeast Brazil: cross-sectional study of prevalence and risk indicators

AIM

The aim of this cross-sectional study was to evaluate the prevalence of destructive periodontal disease and its risk indicators in adult Kiriri Indians from Northeast Brazil.

MATERIALS AND METHODS

Full-mouth periodontal examinations were performed on a sample of 215 Indians (≥19 years). Bivariate analyses and logistic models were applied to assess associations between periodontitis and its putative risk factors.

RESULTS

Prevalence of clinical attachment loss of ≥3, ≥5 and ≥7 mm was 97.8%, 63.8% and 30.8% respectively. Percentage of teeth per individual showing clinical attachment loss of ≥3, ≥5 and ≥7 mm was 49.8%, 18.4% and 8.0% respectively. After adjustment for covariates, individuals aged ≥35 years (OR = 5.83, 95% CI: 3.09-11.00; p < 0.001), men (OR = 2.18, 95% CI: 1.15-4.11; p = 0.02) and diabetics (OR = 3.92, 95% CI 1.03-14.99; p = 0.05) had a higher risk for destructive periodontitis, classified according to the CDC/AAP case definition.

CONCLUSION

Though periodontitis was highly prevalent in Kiriri Indians, only few teeth showed advanced disease, and periodontitis was associated with higher age, male sex and diabetes. A public health action that includes programs of prevention and treatment targeting high-risk groups is vital to improve the periodontal status of this population.

Periodontal outcomes and social, racial and gender inequalities in Brazil: a systematic review of the literature between 1999 and 2008

The objective of this study was to review the Brazilian epidemiologic literature on periodontal outcomes and socio-demographic factors, assessing bibliographic and methodological characteristics of this scientific production, as well as the consistency and statistical significance of the examined associations. A systematic review was carried out in six bibliographic sources. The review was limited to the period between 1999 and 2008, without any other type of restriction. Among the 410 papers identified, 29 were included in the review. An increasing number of articles, specifically in the last four years of study, was observed. However, there is a concentration of studies in the South and Southeast regions of Brazil, and many of them are not closely connected to theoretical formulations in the field. In spite of these shortcomings, the review findings corroborate the idea that poor socioeconomic conditions are associated with periodontal outcomes, as demonstrated primarily by income and schooling indicators.

Comparison of periodontal parameters in individuals with syndromic craniosynostosis

Craniosynostosis syndromes are characterized by premature closure of one or more cranial sutures, associated with other malformations, the most frequent of which are the Crouzon and Apert syndromes. Few studies in the literature have addressed the oral health of these individuals. The purpose of this study was to compare the periodontal status of individuals with Apert, Crouzon, Pfeiffer and Saethre-Chotzen syndromes before toothbrushing and compare the efficiency of plaque removal before and after mechanical toothbrushing. The probing depth, plaque index (according to Löe and O'Leary), clinical attachment level, gingival index (according to Silness and Löe) and amount of keratinized mucosa were evaluated before toothbrushing, and the O'Leary plaque index was assessed before and immediately after toothbrushing, on the same day, in 27 individuals aged 11 to 36 years. There was statistically significant difference in the mean probing depth and clinical attachment level among regions (p=0.00; p=0.01, respectively). The gingival index did not reveal statistically significant differences. With regard to the plaque index, the left region exhibited higher plaque index values than the right and anterior regions. No significant results were found in the analysis of keratinized mucosa. Comparison of the O'Leary plaque index before and after toothbrushing revealed statistically significant difference for all syndromes except for the Pfeiffer syndrome (p<0.05). In conclusion, there was no difference in the periodontal status among individuals with syndromic craniosynostosis. The posterior region was more affected than the anterior region as to the presence of plaque, loss of insertion and probing depth. Individuals with Pfeiffer syndrome exhibited greater toothbrushing efficiency than individuals with the other craniosynostosis syndromes.

Periodontal attachment loss in an untreated isolated population of Brazil

BACKGROUND

The aim of this study was to assess the prevalence, extent, and severity of clinical attachment loss (CAL) and to investigate the association of demographic, socioeconomic, and behavioral risk indicators with CAL in an untreated isolated population in Brazil.

METHODS

All subjects aged > or =12 years were identified by a census. Participants were submitted to a full-mouth clinical examination of six sites per tooth and were interviewed using a structured, written questionnaire.

RESULTS

Among the 214 subjects who were interviewed and examined clinically, CAL > or =5 mm in at least one site was observed in 8% of the 12- to 19-year-olds and in all dentate subjects > or =50 years of age; the age-dependent prevalence of CAL > or =7 mm in at least one site ranged from 5% among 12- to 19-year-olds to 83% among subjects > or =50 years old. Multivariate analysis identified plaque (odds ratio [OR] = 2.8), supragingival calculus (OR = 2.9 to 10.6), age > or =30 years (OR = 11.4), and smoking (OR = 2.4) as risk indicators for CAL > or =5 mm and smoking (OR = 8.2) as a risk indicator for CAL > or =7 mm.

CONCLUSIONS

CAL is highly prevalent in this isolated population. The high occurrence of CAL in young age groups and the confirmation of traditional risk indicators for CAL in this study suggest that other factors, such as host susceptibility, may be needed to explain the high levels of CAL found. Age and behavioral factors were risk indicators associated significantly with the CAL found in this population and may be useful indicators of high-risk subjects for periodontal diseases.

A community-based epidemiological study of periodontal disease in Keelung, Taiwan: a model from Keelung community-based integrated screening programme (KCIS No. 18)

AIMS

To estimate the prevalence and severity of periodontal disease (PD) in the Taiwanese population aged 35-44 years and to investigate the association between demographic factors and PD.

MATERIALS AND METHODS

Between 2003 and 2005, residents of Keelung of the appropriate age were invited to screening. The community periodontal index (CPI) and loss of attachment (LA) index were used to measure the periodontal status at subject (prevalence) and sextant levels (severity). Basic demographic information was also collected by a questionnaire.

RESULTS

Of 8462 enrollees, 94.8% had some signs of PD, of whom 29.7% had periodontal pockets >3 mm and 35% LA >3 mm. Calculus was the most common problem in terms of both prevalence (49.6%) and severity (affecting an average of 3.0 sextants per person). Risk factors for poor periodontal status (as measured by CPI) were older age (odds ratio, OR: 1.44), male gender (OR: 2.70), low education level (OR: 1.40), and being a manual worker (OR: 1.51). Similar findings were observed for LA.

CONCLUSION

The prevalence of PD in 35-44-year-olds was found to be high in this large community-based study of screening for PD with CPI and LA. Poorer periodontal health was observed in males, the less educated, and manual workers.

Periodontal disease in Kuna albinism: a comparative study

BACKGROUND

In classic albinism, all parts of the body are normal except for the absence of melanin. It is believed that lack of this pigment in periodontal tissues might influence periodontal disease progression. This study was designed to determine the relationship between periodontal diseases and albinism by comparing the clinical periodontal status of a group of native Panamanian Kuna albinos (from San Blas, Panama) to Kuna non-albinos of the same communities.

METHODS

An experimental group of 30 subjects (Kuna albinos aged > or =12 years) was selected and divided into three subgroups according to age. Likewise, a control group of 30 subjects (Kuna non-albinos) was selected and divided in subgroups.

RESULTS

Assessment of oral hygiene and gingival inflammation in albinos by the Silness and Löe plaque index and Löe and Silness gingival index, respectively, was unremarkable compared to control groups. No statistically significant differences were found for number of teeth present, gingival index, plaque index, clinical attachment loss (CAL), probing depth, or gingival recession. As expected, age was a factor in the severity of the periodontal disease; 58% of individuals aged > or =36 years had at least one site with CAL > or =7 mm.

CONCLUSION

Based on the overwhelming similarity of results found between experimental and control groups, albinism does not represent a clinical risk factor in the pathogenesis or exacerbation of periodontal diseases for these individuals.

Risk factors and prevalence of periodontitis in community-dwelling elders in Mexico

AIM

The objective of this study was to determine whether an association existed between chronic systemic diseases/conditions, risk factors common in old age, and the extent and severity of chronic periodontal disease.

MATERIALS AND METHODS

Sociodemographic and lifestyle characteristics were examined by contrasting rural, urban-marginal, and urban social environments in Central Mexico. Data were analysed with Analysis of Variance, chi2 tests, and multivariable logistic regression.

RESULTS

A total of 473 adults 60 years old and over were interviewed; 315 were also examined and underwent laboratory assays (participation rate, 66%); women, 62%; mean age 73+/-8 years; 23% edentulous. The distribution of periodontitis by sociodemographic variables showed differences across locales (73% low-urban, 57% middle-urban, 29% rural). The regression model indicated that periodontitis was more frequently associated with low-urban locale, higher systolic blood pressure, higher body mass index, and worse calculus readings, with an interaction whereby being obese and having a high calculus index was associated with a high probability of having periodontitis.

CONCLUSIONS

Overall periodontal conditions were fair. While we identified oral, systemic, and social variables that modulated the experience of periodontitis, it would appear that urban, low social class elders appeared to have worse periodontal conditions.

Periodontal diseases

The periodontal diseases are highly prevalent and can affect up to 90% of the worldwide population. Gingivitis, the mildest form of periodontal disease, is caused by the bacterial biofilm (dental plaque) that accumulates on teeth adjacent to the gingiva (gums). However, gingivitis does not affect the underlying supporting structures of the teeth and is reversible. Periodontitis results in loss of connective tissue and bone support and is a major cause of tooth loss in adults. In addition to pathogenic microorganisms in the biofilm, genetic and environmental factors, especially tobacco use, contribute to the cause of these diseases. Genetic, dermatological, haematological, granulomatous, immunosuppressive, and neoplastic disorders can also have periodontal manifestations. Common forms of periodontal disease have been associated with adverse pregnancy outcomes, cardiovascular disease, stroke, pulmonary disease, and diabetes, but the causal relations have not been established. Prevention and treatment are aimed at controlling the bacterial biofilm and other risk factors, arresting progressive disease, and restoring lost tooth support.