Prevalence of different forms of periodontitis in patients visiting Government Dental College and Hospital, Hyderabad, since last decade: A retrospective study.

CONTEXT: Periodontitis is a highly prevalent oral disease affecting a wide range of people across all age groups and genders. It is the major cause of loss of teeth among all other oral diseases affecting the people. AIMS: The current study aimed to evaluate the prevalence of different forms of periodontitis in patients visiting Government Dental College and Hospital, Hyderabad, over a period of 10 years. SETTINGS AND
DESIGN: Retrospective study.
MATERIALS AND METHODS: This retrospective analysis was put into execution to evaluate the prevalence of periodontal diseases in 74,414 patients referred to the Department of Periodontics in Government Dental College and Hospital, Hyderabad, from January 2007 to December 2016. STATISTICAL ANALYSIS USED: Descriptive analysis, Chi-square test.
RESULTS: Out of the 74,414 patients who were screened, 38,898 were male and 35,516 were female. A total of 67,236 patients (90.35%) had chronic periodontitis and 7178 (9.64%) had aggressive periodontitis. The most commonly found type was chronic localized periodontitis.
CONCLUSION: The results of this study have helped to ascertain the various forms of periodontitis in the population of Hyderabad. This can serve as a basis for future studies with the idea of finding ways to ameliorate oral health in this population.

INTRODUCTION

Periodontal disease is one of the major dental diseases resulting in tooth loss in human beings across the globe, posing a harmful impact on individuals' quality of life. Hence, it is necessary to know the true prevalence of the disease, depending on which appropriate strategies can be rendered.

The final intendment of epidemiology is to apply the dogma gained from studies to “foster, fortify, and refurbish health” for planning of national or regional oral health promotion programs, to prevent and treat oral health problems.

Thus, the present retrospective study was undertaken to evaluate the prevalence of the various forms of periodontitis from the records of the outpatient Department of Periodontics, Government Dental College, Afzalgunj, spanning over 10 years, 2007–2016.

MATERIALS AND METHODS

The present retrospective study was conducted in the Department of Periodontics, Government Dental College and Hospital, Afzalgunj, Hyderabad. Previous outpatient department (OPD) records were reviewed from dental case records of patients who attended the hospital for dental services during the period of January 2007–December 2016.

Routinely, in the department, full-mouth periodontal examinations to assess periodontal status would be done with the aid of mouth mirrors and William's periodontal probes. Four sites per tooth would be examined namely mesio-buccal, mid-buccal, disto-buccal, and palatal sites. The probe would be introduced into the gingival sulcus following the length of the tooth until resistance is felt by the penetrating probe. Probing depths would be rounded to the closest 0.5 mm and when the measurement is halfway between 2 marks on the probe, the closest millimeter immediately above the mark would be recorded. Final diagnosis is recorded, by the trained postgraduates and experienced periodontists, based on the American Academy of Periodontology case definitions for surveillance of periodontitis.[12] This has been the main source of data for our present retrospective study.

The study participants were classified into four representative groups, namely localized chronic periodontitis (LCP), generalized chronic periodontitis (GCP), localized aggressive periodontitis (LAP), and generalized aggressive periodontitis (GAP), and a diagnosis was made.

This study was carried out with the support of the institution's research ethical committee.

RESULTS

The prevalence of periodontitis in participants was established by tabulating the results in an Excel sheet. Descriptive analysis using Chi-square test was performed. And also, the results of the four representative groups, namely LCP, GCP, LAP, and GAP, were expressed as percentages.

The total number of periodontitis patients summed up to 74,414, of which 38,898 were reported to be male and 35,516 were female.

Out of the 74,414 periodontitis patients, 67,236 were diagnosed with chronic periodontitis, which included both localized and generalized forms, and 7178 patients were diagnosed with aggressive periodontitis, which also included both localized and generalized forms. The prevalence of chronic periodontitis (90.35%) was significantly higher than that of aggressive periodontitis (9.64%) in the sample population (P = 0.00) [Table 1].

Table 1

Distribution of chronic and aggressive forms of periodontitis among the study population from 2007 to 2016

Periodontitis	n (%)
Chronic	67,236 (90.35)
Aggressive	7178 (9.64)

n – Sample size

The gender-wise distribution of periodontitis in the sample population from 2007 to 2016 is summarized in Table 2.

Table 2

Distribution of chronic periodontitis among the study population

Years	n (%)
2007	6863 (90.24)
2008	5430 (87.94)
2009	4822 (90.75)
2010	6289 (89.25)
2011	6603 (90.51)
2012	8856 (94.15)
2013	7376 (89.08)
2014	7442 (88.83)
2015	6874 (91.38)
2016	6620 (91.03)

n – Sample size

In chronic periodontitis group which included both localized and generalized forms, males were 35,361 and females were 31,875. Although the prevalence of periodontitis was higher among males, it has not translated into statistical significance (P = 0.24).

In aggressive periodontitis group which included both localized and generalized forms, males were 3601 and females were 3651. Although the prevalence of periodontitis was higher among females, it has not translated into statistical significance (P = 0.82).

The year-wise distribution of chronic periodontitis is summarized in Table 3 and that of aggressive periodontitis in Table 4.

Table 3

Distribution of aggressive periodontitis among the study population

Years	n (%)
2007	742 (9.75)
2008	744 (12.05)
2009	491 (9.24)
2010	757 (10.74)
2011	692 (9.48)
2012	550 (5.84)
2013	904 (10.91)
2014	935 (11.16)
2015	648 (8.61)
2016	652 (8.96)

n – Sample size

Table 4

Gender-wise distribution of periodontitis among the study population for 10 years

Years	Males (%)	Females (%)
2007	50.17	49.82
2008	54.03	45.96
2009	51.89	48.10
2010	55.71	44.28
2011	52.94	47.05
2012	53.59	46.40
2013	50.88	49.11
2014	52.04	47.95
2015	50.78	49.21
2016	51.77	48.22

Among the LCP group, males were 18,340 and females were 16,536; among the GCP group, males were 17,021 and females were 15,368; among the LAP group, males were 1931 and females were 1949; and among the GAP group, males were 1606 and females were 1692.

The prevalence rates of the four forms of periodontitis in terms of percentages are shown in Table 5.

Table 5

Prevalence of the study

OP cases	Prevalence (%)
	Male	Female	Male + female
CLP	47.15	46.56	46.85
CGP	43.76	43.27	43.51
LAP	4.96	5.49	5.23
GAP	4.13	4.76	4.45
CLP + CGP	90.91	89.75	90.33
LAP + GAP	9.09	10.25	9.67

CLP – Chronic localized periodontitis; CGP – Chronic generalized periodontitis; LAP – Localized aggressive periodontitis; GAP – Generalized aggressive periodontitis; OP – Out patient

DISCUSSION

The present retrospective study aimed to ascertain the prevalence of periodontal disease from the previous OPD records of the patients who attended the hospital for dental services during the period of January 2007–December 2016.

The United States was foremost in position to identify the importance of surveys in the determination of periodontal diseases' prevalence with their benchmark NHANES I survey conducted between 1971 and 1974 on a probability sample of approximately 28,000 patients.[3]

The NHANES III survey was conducted between 1988 and 1994 which concluded that 3.1% were diagnosed with advanced periodontitis, 9.5% with moderate periodontitis, and 22% with mild periodontitis.[4]

The World Health Organization reported that 10%–15% of the worlds' population suffers from severe periodontitis.[5]

Albandar and Rams in an overview arrived at a judgment that individuals of Asian ethnicity had the third highest prevalence of periodontitis.[6]

The two benchmark studies done in India are described in the following sections:

National Oral Health Survey and Fluoride Mapping (2002–2003), Dental Council of India, New Delhi, 2004

This is the first-ever national-level epidemiological survey done in India where the prevalence was found to be 57%, 67.7%, 89.6%, and 79.9% in the age groups of 12, 15, 35–44, and 65–74 years, respectively.[7]

The Government of India and World Health Organization collaborative program on oral health in India, 2007 (Mathur, 2007)

The general trend observed was that rural population showed more loss of attachment than urban population and males were found to have higher scores than females. In the geriatric age group, the prevalence of loss of attachment was more among females.[8]

The four different forms of periodontitis included were LCP, GCP, LAP, and GAP.

The total number of patients having periodontitis summed up to 74,414, of which 67,236 were diagnosed with chronic periodontitis, which included both localized and generalized forms, and 7178 patients were diagnosed with aggressive periodontitis, which also included both localized and generalized forms.

Out of the total 74,414 patients, 38,898 were reported to be male and 35,516 were female.

Among the entire study population, 67,236 were diagnosed with chronic periodontitis, which included localized form involving 34,847 and generalized form involving 32,389 patients.

In the current study, the prevalence of chronic periodontitis was found to be 90.33%. The results are in accordance with the studies done by Singh et al.[9] and Bansal et al.[10]

Out of the total number of patients diagnosed with chronic periodontitis, i.e., 67,236, 35,361 were male and 31,875 were female. This is in accordance with studies done by Doifode et al.,[11] Kundu et al.,[12] and Sekhon et al.[13] which have concluded that periodontal disease was more common in males, with the explanation put forward being the deleterious oral habits which are more prevalent in male population.

Considerably less epidemiological data were available on aggressive periodontitis than on chronic periodontitis.[14]

Out of the total number of patients, 7178 were diagnosed with aggressive periodontitis which included localized form involving 3880 and generalized form involving 3298 patients.

In the present study, the prevalence of aggressive periodontitis was shown to be 9.67%. Patients with the localized form (5.23%) were slightly higher as compared to those with the generalized form (4.45%). The results are in accordance with those reported by Sharma and Rai, stating that those diagnosed with LAP (57%) were slightly high when compared with those diagnosed with GAP (43%).[15] In contrast, in a study by Imran and Ataa on Yemeni students, individuals with LAP (2.6%) were much higher compared to those with GAP (1%).[16] Similarly, Kumar et al. described a higher prevalence of LAP (71%) as compared to GAP (29%).[17] The variation in prevalence ratios in these previous studies as compared to the present study may reflect the influence of the genetic and environmental factors due to the varying geographical locations.

In the present study comprising 7178 aggressive periodontitis patients, 3537 were found to be male and 3641 were female, with a ratio of 0.9, showing a positive relationship between the female gender and the occurrence of aggressive periodontitis. These results are similar with those reported by Cortelli et al.,[18] Hørmand and Frandsen,[19] and Baer.[20]

In the present study, 67,236 patients were diagnosed with chronic periodontitis, which was significantly higher than that of aggressive periodontitis which constituted 7178 patients only. This is in accordance with the results reported by Sharma and Rai.[15]

CONCLUSION

The results of the study have helped to ascertain the various forms of periodontitis in the population of Hyderabad. This can serve as a basis for future studies with the idea of finding ways to ameliorate oral health in this population.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.