A survey on the awareness of interrelationship of periodontal disease and systemic health among Mahe population.

BACKGROUND: Systemic health is the fundamental right of any individual, and it cannot be attained or maintained without oral health. Oral cavity is the gateway and the mirror of health. This link is often ignored. This lack of understanding of the correlation between oral and systemic health often leads to the poor systemic health because of the poor oral status. AIM: The aim of the study was to assess the awareness among the general public about periodontal diseases and its impact on systemic health.
MATERIALS AND METHODS: A questionnaire with 15 questions including general awareness about periodontitis and its impact on systemic health were given to patients and were asked to select their preferred option of yes, no, and don't know. The awareness of the individuals was categorized based on their educational qualification, age, and gender as well.
RESULTS: The results obtained showed increased awareness among females, postgraduates, and 35-50 years group of individuals according to their category of gender, education, and age group, respectively.
CONCLUSION: There is always a strong influence of oral health on systemic well-being. This link among the two is often ignored and overlooked. Oral health upholds the overall well-being of the patient. Further studies need to be conducted on large scale population and camps need to be conducted to increase the awareness among the general public of periodontal diseases and their systemic impact. Copyright:

INTRODUCTION

Oral health is an inevitable and essential requisite for the systemic well-being of an individual. The systemic health of an individual depends on the degree of oral hygiene maintenance.[1] A wide variety of microbes are found in the oral cavity.

It is well known that a periodontal disease if left untreated leads to recession, loss of attachment, and mobility eventually leading to loss of tooth.[2] It also has systemic influence which is not as well-known as its local effects, and it should be educated to common people [Table 1].[3]

Table 1

Mechanism of infection from oral cavity to systemic diseases

Pathways of oral infections	Possible systemic diseases
Through transient bacteremia	Subacute bacterial endocarditis, acute bacterial myocarditis, brain abscess, Ludwig’s angina, cavernous sinus thrombosis, sinusitis, ling abscess/infection, orbital cellulitis, etc.
By circulation of oral microbial toxins	Acute myocardial infarction, cerebral infarction, persistent pyrexia, abnormal pregnancy, toxic shock syndrome, chronic meningitis, systemic granulocytic cell defects, etc.
Immunological injury from oral organisms	Behcet’s syndrome, uveitis, chronic urticaria, inflammatory bowel disease, Crohn’s disease

Literary search on diverse epidemiological studies has revealed the worldwide occurrence and prevalence of periodontitis.[4] It is alarming to see the significant rise in the incidence of periodontal diseases in recent times. Severe form of periodontitis is the sixth most prevalent disease with higher prevalence worldwide.[5] Prevention is always better than cure. To prevent any disease, awareness about the concerned disease is mandatory. This awareness needs to be enhanced by patient education. The knowledge about periodontitis and its systemic impact needs to be made aware to the general public to aid them in maintaining their oral as well as systemic health.[6] There are various steps that can be taken to aid in this. For example, periodic visits to dental surgeon for oral prophylaxis, oral health maintenance, and lifestyle modification like abstaining from smoking.

The role of a periodontist is crucial in creating awareness to the patients regarding this systemic interrelationship. As a first step toward educating the patient, we have conducted a questionnaire based study among the general public population attending the outpatient department (OPD) of Department of Periodontics, to assess their awareness on the periodontal-systemic interrelationship.

MATERIALS AND METHODS

Inclusion criteria

A total of 317 outpatients with minimal education qualification of high school education, above the age of 20, attending the OPD of department of periodontology were included in the study. In case of postgraduate individuals, individuals with postgraduation in any subjects other than medical, dental, and paramedical courses were included in the study.

Exclusion criteria

(a) Patients without schooling and (b) medical, dental, and paramedical individuals.

A questionnaire containing 15 questions pertaining to the link between periodontal health and general health, along with demographic details was given to the patients. The questions were grouped based on general awareness toward periodontitis, interrelation between periodontitis, and various factors such as smoking, nutrition, diabetes, cardiovascular disease, and pregnancy. The individuals were allowed to select from three options: YES, NO, and DON'T KNOW. The questionnaires were then evaluated for their responses.

The questions were categorized into six groups: A, B, C, D, E, and F.

Group A – Questions were based on the general awareness on periodontitis

Group B – Interrelationship between smoking and periodontitis

Group C – Effects of nutrition on periodontium

Group D – Influence of diabetes on periodontium

Group E – Cardiovascular system effects on periodontium

Group F – Effects of pregnancy on periodontium.

The individuals were assessed based on their age, gender, and qualification.

Statistical analysis

Chi-square test was used to find the association between the variables, to determine the significant differences between the frequencies in one or more categories. SPSS version 22.0 SPSS version 22.0, (IBM Corp, Armonk, NewYork) was used.

RESULTS

The study comprised of 317 general population attending the OPD of the department of periodontology.

Out of 317 individuals, according to gender specification, 156 were females and 161 were males.

According to age group, 147 individuals were <35 years, 109 individuals were 35–50 years, and 61 individuals were >50 years.

Based on educational qualification, 127 who completed high school education, 172 graduates, and 18 postgraduates were enrolled for our study.

The responses of the 317 individuals were evaluated. Figure 1 shows the overall awareness level among the 317 individuals.

Figure 1

Overall awareness of survey population. Greater proportion of individuals were aware on periodontal and systemic interrelationship

The individuals were most aware about the detrimental effects of smoking on the periodontium and least aware about the effects of periodontal disease on the cardiovascular system as well as pregnancy [Figures 2 and 3].

Figure 2

Awareness based on categories of questions. Distribution of awareness among the question categories

Figure 3

Graph comparing awareness level based on category. Awareness level low for pregnancy and chorionic villus sampling effects on periodontium

Females were found to have higher level of awareness than males [Figure 4]. Based on level of education, postgraduates were found to be most aware of this interrelationship [Figure 5].

Figure 4

Awareness based on gender. Females have higher awareness than males in all question categories

Figure 5

Awareness based on educational qualification. Increased awareness level with increase in education qualification

Based on the age group on an average, the group of individuals 35–50 years were found to have higher awareness level than the other two groups [Figure 6].

Figure 6

Awareness based on age group. 35–53 year age group have higher awareness level in all question categories

DISCUSSION

Accumulation of plaque and calculus causes sequelae of reactions leading to gingivitis and if not treated, periodontitis.[78] Poor oral health not only causes gingivitis and periodontitis but also impacts the systemic health. Periodontitis is known to have various systemic relationships with endocrine system, cardiovascular system, etc.[9] This systemic interrelationship if understood correctly will enhance both oral and systemic health.[1011] Individuals with higher awareness were found to have good glycemic control than the unaware population.

The results of our study showed that the general awareness level of patients on periodontitis was good with a percentage of 78%. This result was found to be contradictory to the result seen in a study conducted by Bhatia et al.[12] which showed a poor awareness among the study conducted among North Indian population. This higher level of awareness might be due to the higher literacy level of the survey population at Mahe region.

Awareness level of females was found to be higher than males in our study. These results signify the increased level of awareness of females on periodontitis and its systemic interrelationship than males. These results were in accordance with the results of Gupta et al.[13] where females were aware than males.

Postgraduates had higher awareness than the other two study groups. This increased awareness could be attributed to their higher education level. This result was in contrary to the results of other study, where the individuals with least educational qualification had higher knowledge on awareness.[14]

In our study, the awareness of 35–50 years age group was higher than other ages. This result was found to be in contrast to the study done among Andhra Pradesh population where the age group of 18–24 years had higher awareness.[14]

However, this study reveals a low awareness about the detrimental effects of periodontal disease on pregnancy and chorionic villus sampling. Increased levels of Prostaglandin E2 is significant of Chronic inflammation like Periodontitis. Periodontopathic bacteria and high levels of Prostaglandin E2 have been identified in the amniotic fluid of women who had preterm birth.[1516] This can lead to several pregnancy-related complications such as low birth weight, preterm delivery, and preeclampsia.[17] Interdisciplinary approach with regard to oral health care during pregnancy can enhance the quality of maternal and fetal health. Pregnant women must be enrolled under a strict oral hygiene maintenance program from their first trimester.

Number of patients consuming antihypertensive drugs for hypertension is alarming, and there are remote chances for patients to be aware that some of the antihypertensive drugs have the potential to cause gingival hyperplasia. Awareness must be created among cardiac patients for the potential risk for cardiac accidents due to periodontitis.

From the results obtained in our study, it was evident that the public had a general awareness about the link between periodontal disease and systemic health. Hence, with due motivation of the patients, periodontal maintenance and attaining healthy oral hygiene would be easily achievable. Patients with systemic diseases must be distinguished from other patients and advocated to have a strict recall visit in dental OPD.

The general public must be made aware that self medication might mask a serious underlying perIodontal and systemic problem. Timely professional advice should be pursued to ensure oral and systemic well-being.

Enhance public awareness

Improve access to periodontal care

Upgrade awareness on standard of professional care for periodontitis

Enhance public awareness of the potential of undergoing timely periodontal treatment in saving medical care.

CONCLUSION

General public needs to be educated on the benefits of maintaining good oral hygiene. Treating periodontitis is known to decrease the risk of cardiovascular accidents like atherosclerosis in cardiac patients and also found to influence the premature childbirth and decreased birth weight of the babies.[1819] The impact of nutritious food on gingival health also needs to be emphasized to the patient.[20] Periodontal health care should also be incorporated into primary and community health services. Dental awareness must be intensified by awareness programs, camps, and through social media. Further studies need to be conducted on larger sample size and with individualized questionnaire for specific systemic complications to evaluate the results of our study. Patients with systemic complications which have impact on oral care must be penned down to a recall visit protocol for their overall well-being.

Limitations of the study

Spacing of population based on education qualification should have been equal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Serial number	Questionnaire	Yes	No	Don’t know
1	Are you aware of disease affecting the gums known as gum disease (or) periodontitis
2	Are you aware about the symptoms of gum disease like bleeding gums, loose teeth and pus discharge?
3	Do you think gum diseases are preventable?
4	Do you think gum diseases are hereditary?
5	Do you know that gum disease is one of the main reason for causing bad breath?
6	Are you aware that good oral health can lead to improvement in overall health of an individual?
7	Are you aware that a majority of smokers have severe gum disease?
8	Are you aware that nutritional deficiencies (vitamins) in the diet can lead to oral ulcers and bleeding gums?
9	Did you know patients with high sugar level have higher incidence of tooth loss?
10	Did you know that high blood sugar level can increase the risk of infection in the oral cavity?
11	Do you think gum disease can affect blood glucose level in a sugar patient?
12	Were you aware that microbes causing gum disease can lead to narrowing of the blood vessel supplying the heart, leading to various heart diseases?
13	Did you know certain tablets given for blood pressure can increase the size of the gums?
14	Do you know that there is an increased tendency for bleeding gums and enlargement of gums during pregnancy?
15	Are you aware that gum disease can cause premature deliveries , low birth weight babies?