Periodontal status of a given population of West Bengal: An epidemiological study.

BACKGROUND: This paper presents the prevalence and severity of periodontal disease in a given population of West Bengal and its relationship with their age, sex, socioeconomic status, educational background, and dietary habits. Also, the treatment needs on the basis of Community Periodontal Index of Treatment Needs (CPITN), which might be helpful for future planning of dental services.
MATERIALS AND METHODS: A sample of 22,452 individuals aged 15 years and above was selected using a random cluster sampling from the population. All the subjects sampled were weighed by age, sex, community, income group, educational level, diet pattern, and habitation. The WHO CPITN was used to assess the levels of periodontal condition and treatment needs.
RESULTS: Score 2 was most prevalent in all the groups. Periodontal disease is widespread in West Bengal and a positive relation appears to exist between age, sex, socio-economic status, education level, and dietary habits with periodontal status. Comprehensive oral hygiene instruction and dental prophylaxis need to be initiated.
CONCLUSION: The data on periodontal conditions presented in this study are similar to data available from WHO on global oral health. These estimates are important for the future planning of dental services in the state.

INTRODUCTION

Periodontal disease is one of the most prevalent dental diseases affecting the whole adult population throughout the world varying only in degree from mild to severe depending on multiple factors.[127] It is more prevalent in the developing countries.[4-6] The prevalence of periodontitis has been reported after various epidemiological studies conducted in different parts of globe signifying its need for control at various levels of involvement using different periodontal indices.[127] Since the 1940s, there has been a great general interest among the epidemiologists for the development of a suitable index system for quantification of the prevalence and severity of the periodontal diseases of individuals as well as of the group of population in all parts of the world.[8] Community Periodontal Index of Treatment Needs (CPITN) was jointly developed by WHO and Federation Dentaire Internationale (FDI)[9] and since then it has been used worldwide to study the periodontal disease in population at community level, as well as its treatment needs. It is claimed to be a simple, rapid, inexpensive, easily applied index, which requires minimum equipments, is widely applied and has an international uniformity.[10] However, concerning CPITN index, very few references are available so far in the literature of epidemiological study in India, either organized by WHO or individually utilizing this index.

AIMS AND OBJECTIVES

To study the prevalence and severity of periodontal disease in a given population of West Bengal, India, and to find out its relationship with people's socioeconomic status, educational background, dietary habits, occupation, age, and gender.

To study the periodontal treatment needs of the population, which might be helpful for the national oral health policy making and specific interventions against the periodontal disease.

MATERIALS AND METHODS

A sample of 22,452 individuals aged 15 years and above was selected using a random cluster sampling from the population. The examination was performed by conducting several dental checkup camps in different places in Kolkata and other parts of West Bengal, either personally or along with Indian Dental Association (West Bengal State Branch). Dental examination was carried out using a portable chair, portable light, No.4 dental mirrors, No.5 explorers, and specially designed WHO periodontal probes. Asepsis protocol was established. All the subjects were evaluated by age, gender, community, income group, educational level, diet pattern, and habitation. All the subjects were divided into five age groups namely 15–19 years, 20–29 years, 30–44 years, 45–64 years following the pattern of Ainamo et al.[9] , and a further elderly group of 65 years and above as per Sivaneswaran and Barnard[11] was also included. Based on the surveys conducted in 1999–2000 by National Council of Applied Economics Research, the subjects were divided into five income groups as low, lower middle, middle, upper middle, and high. In terms of education, the subjects were divided into the following categories: illiterate, those who studied up to secondary school level, and those who studied above secondary school level. Subjects were also divided as non-vegetarians and vegetarians. Various communal groups selected for the study were – Bengali, Bihari, Gujarati, Marwadi, Marathi, Punjabi, Tribal, Muslims, and Tamils.

The WHO CPITN[9] was used to assess the levels of periodontal condition and treatment needs. The dentition was divided into six sextants. Each sextant was assigned a code number and the condition of the worst affected site in that segment was recorded. The subjects were classified into the treatment need types according to the highest code number assigned to any sextant of their mouth. Statistical analysis of the collected data was performed in the Indian Statistical Institute (ISI), Kolkata using Chi-Square test.

RESULTS AND OBSERVATIONS

Table 1 shows that score 2 was the most prevalent in all age groups. The age-based variation was statistically significant.

Table 1

Prevalence of the highest CPITN score for each age group

Table 2 shows number, mean number, and percentage of sextants affected by different scores in different age groups.

Table 2

Number, mean number, and percentage of sextants affected by different scores in different age groups

Table 3 reveals that females were periodontally more healthy as compare to males and the difference was statistically significant.

Table 3

Prevalence of the highest CPITN score for each sex group

Table 4 shows prevalence of the highest CPITN score for each family monthly income group. There is a statistically significant rise in the percentage of healthy sextants from lower middle income group to higher income groups.

Table 4

Prevalence of the highest CPITN score for each family monthly income group

Table 5 reveals prevalence of the highest CPITN score for each educational status group. Periodontal health significantly improves with increase in education level.

Table 5

Prevalence of the highest CPITN score for each educational status group

Table 6 depicts prevalence of highest CPITN scores for various community groups.

Table 6

Prevalence of highest CPITN scores for various community groups

Maximum numbers of sextants were with Score 2 in all age groups in all the communities.

Table 7 shows prevalence of the highest CPITN score for each diet group. Vegetarian people had a significantly higher number of healthy sextants.

Table 7

Prevalence of the highest CPITN score for each diet group

DISCUSSION

In India, periodontal disease is responsible for the loss of 79.2% of all teeth in all patients over 30 years of age.[12] Considering its universal involvement, periodontal disease requires its need to control at various levels of involvement. Different variables have been included in this study and we tried to determine whether any relationship existed between the prevalence of periodontal disease with the variables used.

In the present study, the mean number of healthy sextants decreased with advancing age. The mean number of edentulous sextants and sextants affected by Score 4 shows a steady rise with age. These age-based variations were statistically significant.th

Percentage of healthy sextants was prominent in females (6.3%) than in males (3.8%), the difference being statistically significant. This might be due to the fact that females are more aware about maintenance of their oral hygiene and regular professional dental care. Males are more exposed to deleterious oral habits like tobacco chewing and smoking, which are established as high risk factors for periodontal diseases. The number of mean sextants affected by periodontal pathologies were seen more in males than in females in many studies.studies[13-15] However, the results were contradictory to the results obtained by some studies[1617], where they did not find any significant difference between males and females.

In the present study, the maximum number of subjects came from lower income group (9728 subjects) and lower middle income group (6057 subjects). There is a statistically significant rise in the percentage of healthy sextants from lower middle income group to higher income groups. Percentage of sextants with Score 4 was minimum for high income group and maximum for low income group.

It is evident that the percentage of healthy sextants rises with the level of education. Percentage of persons affected by score 3 and 4 showed a statistically significant decrease with rise in the education level.

The result of the study showed that vegetarians had more number of healthy sextants (7.9%) than the non-vegetarians (4.5%), the difference being highly significant. These findings are however contradictory to the findings of some other studies where it has been emphasized that prevalence and severity of periodontal disease is more evident among vegetarians. The difference in observations between the studies might be due to disproportionate sample size between the two groups and perhaps more young subjects have been examined under the vegetarians group, which might have affected the findings.

The study sample mainly consisted of the Bengalee subjects, i.e., 11672 subjects. Maximum numbers of sextants were affected by Score 2 in all age groups in all the communities. Number of healthy sextants (sextants with score 0) were maximum seen in Marwaris subjects followed by Gujaratis. This can be explained by the fact that the subjects mentioned in the above two groups mainly belong to middle and high socio economic status that has got a definite impact on dental health.

CONCLUSIONS

Periodontal disease is widespread in West Bengal and appears at an early age. A positive relation appears to exist between age, sex, socioeconomic status, education level, habitation, and dietary habits with periodontal status. The results showed poor periodontal status in all age groups, with most of the population requiring simple therapy. This indicates that comprehensive oral hygiene instruction and dental prophylaxis need to be initiated. The data on periodontal conditions presented in this study are similar to data available from WHO on global oral health. The most effective way to prevent periodontal disease is to control it in childhood and in young adult life. It is especially important to take the advantage of the school setting where it is possible to reach large numbers of school children with well-planned, preventive measures. The availability of estimates of periodontal disease prevalence would greatly improve the calculation of the needs estimates. These estimates are important for the future planning of dental services in the city. Since this is the pioneer study, comprising the representative sample of Kolkata, further studies with a larger sample size is required for a definite conclusion.