Risk indicators for prevalence, extent and severity of periodontitis among rural Indian population aged 35-54 years

Smokeless tobacco and periodontitis: A systematic review with meta-analysis

AIM

The present systematic review with meta-analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries.

METHODS

We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non-users. The quality of studies was evaluated using the 10-item risk-of-bias tool, and publication bias was addressed through the trim-and-fill method. Sensitivity analysis utilized the leave-one-out approach. Meta-analysis and meta-regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation.

RESULTS

From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta-analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non-users (OR = 2.99; 95% CI: 2.10, 4.27; p < .01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high-income countries (OR = 1.69; 95% CI: 1.20, 2.37; p < .01) and even higher in lower-middle-income and lower-income countries (OR = 3.91; 95% CI: 2.66, 5.77; p < .01).

CONCLUSIONS

Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT-periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated.

Prevalence and Risk Factors of Periodontal Disease among Rural and Urban Residents of a South Indian City: A Cross-Sectional Study

Background

The prevalence of oral diseases has been increasing alarmingly in the state of Kerala. Screening for periodontal disease (PD) is crucial due to its negative impact on oral and overall health. Since the occurrence and severity of PD depend on its risk factors, a structured survey in randomly selected districts in the state can be a valuable tool for policymakers to envisage strategies to enhance oral health care and control shared systemic illnesses. Data on the prevalence and risk factors of PD among the residents of the Thiruvananthapuram district of Kerala is not currently available in the public domain. This data could also be representative of the other 13 districts with more or less similar topographical, cultural, and lifestyle characteristics.

Aim

To study the prevalence of PD and its risk factors among the residents of the Thiruvananthapuram district of Kerala and to compare the urban-rural differences.

Materials and Methods

In this community-based cross-sectional study, a multistage cluster random sampling method was used to select the participants. Among the 1285 participants, 560 were from urban areas, and 725 were from rural areas. A modification of the Ramfjord PD index was used to assess periodontal health. The epidemiological risk factors were evaluated using sociodemographic data, personal histories, and physical and biochemical parameters. Multivariate logistic regression was used to determine the relationship of PD with independent variables. Mediation analysis was performed to examine the mediating effects of independent factors.

Results

The rural population (61.4%) had a higher frequency of PD than the urban (35.5%) and an overall prevalence of 50%. Aging, poor oral hygiene, and low educational level (EL) were significant risk factors for PD in urban and rural settings, with hypertension only being significant in the latter. A higher odds ratio (9.07-29.68) with a confidence interval of (5.45-48.94) for poor oral hygiene was noted. Poor oral hygiene and tobacco use had mediating effects between low EL and PD.

Conclusions

In this study, the overall prevalence of PD was 50%, with the rural population being more afflicted. Poor oral hygiene has been identified as a modifiable risk factor for PD in urban and rural populations. Poor oral hygiene and tobacco use have been demonstrated to be mediators of the strong link between low EL and PD. Therefore, this study reiterates the need for better oral health awareness and treatment facilities to minimize the impact of the above risk factors on the periodontium. A shared risk relationship between PD and hypertension in the rural population emphasizes the need for an integrated approach to public health by including oral health as part of noncommunicable disease prevention and intervention programs.

Prevalence of periodontitis in dentate people between 2011 and 2020: A systematic review and meta-analysis of epidemiological studies

AIM

The aim of the study was to evaluate the prevalence of periodontitis in dentate people between 2011 and 2020.

MATERIALS AND METHODS

PUBMED, Web of Science, and LILACS were searched up to and including December 2021. Epidemiological studies reporting the prevalence of periodontitis conducted between 2011 and 2020 were eligible for inclusion in this review. Studies were grouped according to the case definition of confidence as confident (Centers for Disease Control [CDC] AAP 2012; CDC/AAP 2007; and Armitage 1999) and non-confident (community periodontal index of 3 or 4, periodontal pocket depth >4 mm, and clinical attachment level ≥1 mm). Random effects meta-analyses with double arcsine transformation were conducted. Sensitivity subgroup and meta-regression analyses explored the effect of confounding variables on the overall estimates.

RESULTS

A total 55 studies were included. The results showed a significant difference, with confident case definitions (61.6%) reporting nearly twice the prevalence as non-confident classifications (38.5%). Estimates using confident periodontal case definitions showed a pooled prevalence of periodontitis of 61.6%, comprising 17 different countries. Estimates reporting using the CDC/AAP 2012 case definition presented the highest estimate (68.1%) and the CDC/AAP 2007 presented the lowest (48.8%). Age was a relevant confounding variable, as older participants (≥65 years) had the highest pooled estimate (79.3%).

CONCLUSION

Between 2011 and 2020, periodontitis in dentate adults was estimated to be around 62% and severe periodontitis 23.6%. These results show an unusually high prevalence of periodontitis compared to the previous estimates from 1990 to 2010.

Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals

Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.

Self-Rated Oral Health and Associated Factors among an Adult Population in Rural India-An Epidemiological Study

BACKGROUND

To determine the perception of oral health status and its associated factors among adults living in rural areas in Karnataka state, India.

METHODS

A cross-sectional study was conducted among adults in the age group of 35-54 years old residing in villages in a southern state in India. The main outcome measure was poor self-rated oral health (SROH) among adults in rural India.

RESULTS

About 873 adults participated in the study. The prevalence of poor SROH was 15.2%. Adults of age 40-44 years, females, those in lower socioeconomic conditions, and those with high caries experience (DMFT ≥ 4) and periodontal disease were associated with poor SROH. Those who had visited a dentist in the previous one year were 1.9 times more likely to report poor oral health.

CONCLUSIONS

Nearly 15% of rural people reported poor oral health. Socioeconomic conditions, sex, age, smoking, and dental visiting were associated with poor SROH. People's perception of poor oral health was associated with severe periodontitis and DMFT ≥ 4. A dose-response relationship was observed between experience with dental caries and poor SROH.

Current status of periodontitis and its association with tobacco use amongst adult population of Sunsari district, in Nepal

BACKGROUND

Tobacco products are considered significant, but preventable factors related to initiation and progression of periodontal diseases. We assessed the prevalence of periodontitis and evaluated its association with tobacco use and other factors amongst the adult population of Sunsari district in eastern Nepal.

METHODS

A community-based, cross-sectional study was conducted in rural municipalities in the province one of eastern Nepal. A total of 440 adults were interviewed with a set of a pre-tested semi-structured questionnaire. Data on social demographics, adverse oral habits followed by periodontal clinical examination were recorded. Prevalence of periodontitis was assessed by a case definition provided by CDC-AAP. Univariate and multivariate logistic regression analysis was done to measure the association between tobacco use and other factors with periodontitis.

RESULTS

The overall prevalence of periodontitis was found to be 71.6%. Majority (85.4%) of tobacco users had periodontitis and they were significantly associated with the disease and its severity. The study identified age groups, 45-65 years (AOR = 7.58, 95% CI 3.93-14.61), plaque accumulation (AOR = 1.01, 95% CI 1.00-1.02), smoking (AOR = 3.14, 95% CI 1.36-7.27), khaini users (smokeless tobacco, AOR = 2.27, 95% CI 1.12-4.61) and teeth loss (AOR = 2.02, 95% CI 1.21-3.38) as the significant factors associated with periodontitis.

CONCLUSION

The prevalence of periodontitis is high in the surveyed rural adult population. Cigarette smoking along with the use of smokeless tobacco in the form of khaini were identified as significant factors associated with periodontitis.

Natural progression of periodontal diseases in Chinese villagers based on the 2018 classification

BACKGROUND

Based on the 2018 classification, we aimed to determine the prevalence, distribution, and progression of periodontitis in the rural Chinese population without access to dental care.

METHODS

In all, 404 subjects (28.7 ± 8.9 years, M:F = 182:222) were randomly enrolled in 1992 and re-called in 1996. With the new classification, the prevalence and distribution of stage, grade, and extent were characterized. Stage progression was compared with the progression of clinical attachment loss (CAL) and radiographic bone loss (RBL).

RESULTS

At baseline, 94.1% villagers suffered from periodontitis, of whom 53.7% were in stage III/IV. The prevalence of stage III/IV increased from 18.2% in the age group of 15 to 24 years to 60.9% in 25 to 34-year-old group and 88.7% in the 35 to 44-year-old group. Significantly more stage III/IV, generalized, and grade C periodontitis were found in male villagers than female villagers. In 1996, the prevalence rate of periodontitis increased to 98.5%, with 80.0% in stage III/IV. Further, 84.2% villagers presented with grade C periodontitis based on longitudinal ΔCAL. The rate of progression (≥1 site with ΔCAL ≥3 mm) was 63.7%. Stage progression correlated significantly with CAL and RBL progression in stage I/II, but this association was not found in stage III/IV. Among subjects with disease progression in stage III/IV, 90.4% shifted from localized to generalized cases. Furthermore, ceiling effects were observed in stage III/IV.

CONCLUSIONS

In villagers without access to dental care, 94.1% suffered from periodontitis, with more than half having stage III/IV disease based on the 2018 classification. The majority cases presented with rapid periodontal progression. Although stage progression correlated significantly with CAL and RBL progression in stage I/II, ceiling effects existed in stage III/IV.

Relationship between consumption of soft and alcoholic drinks and oral health problems

OBJECTIVES

Oral health can affect quality of life in all course of life, which is a key factor of general health. Dental caries, periodontitis and oral cancer are of the highest burden of oral diseases. Rising prevalence of soft drinks and alcoholic beverages consumption due to easy access and socio-demographic altering has increased the concerns on oral health. In this review our purpose was to show effects of the most consumed beverages on oral health in people older than 15 years.

METHODS

The review was based on papers published in last 10 years, searched with combined key words related to types of drinks and specific oral health problems. We included 4 older studies due to lack of newer studies on subjected topics.

RESULTS

Sugar-free soft drinks are found less cariogenic and erosive than regular versions in limited number of studies. Alcohol consumption is shown as one of the risk factors of prevalence and severity of periodontitis and is proven to have synergistic effects along with tobacco on oral cancer risk. Consumption of soft drinks and alcoholic beverages was related with tooth loss whether dental caries or periodontal diseases.

CONCLUSION

There is good evidence for association between soft drinks and oral health problems, but still no clear answer exists about strength of association between sugar-free soft drinks and dental caries. Also the knowledge about influence of alcohol is inadequate. Since consuming style affects erosive potential of drinks manufacturers should be required to add some recommendations on labels about drinking style.

Cumulative smoking exposure and cessation associated with the recurrence of periodontitis in periodontal maintenance therapy: A 6-year follow-up

BACKGROUND

This study followed individuals in periodontal maintenance therapy (PMT) over 6 years and longitudinally evaluated the effects of cumulative smoking exposure and duration of smoking cessation on the recurrence of periodontitis.

METHODS

From a 6-year follow-up cohort study with 212 individuals in PMT, 142 patients who attended at least one PMT visit within 12 months were determined to be elegible. According to smoking habits they were categorized into three groups: non-smokers (NS; n = 95), former smokers (FS; n = 22), and current smokers (CS; n = 25). Complete periodontal examination and smoking habits were evaluated at two instances: T1 (first time, after active periodontal therapy) and T2 (second time, 6 years). Associations between the recurrence of periodontitis (RP; probing depth ≥4 mm and clinical attachment loss ≥3 mm, together with the presence of bleeding on probing and/or suppuration), smoking status, and potential risk variables were analyzed by univariate and multivariate analysis, when appropriate.

RESULTS

The RP in NS, FS, and CS groups was 44.2%, 68.2%, and 80.0%, respectively. After adjusting for confounders, odds ratios (95% confidence interval) for the RP in T2 was 2.80 (2.11 to 5.14) for FS and 5.97 (3.58 to 9.88) for CS. There was a significant dose-response relationship between pack-years of smoking and the RP, as well as a significant decrease in the risk for the RP as the years of smoking cessation increased.

CONCLUSION

During 6 years of PMT, cumulative smoking exposure and shorter time since smoking cessation were significantly associated with the RP.