|Year : 2017 | Volume
| Issue : 1 | Page : 3-7
The prevalence of gingivitis and periodontal diseases in preschool children in Kolkata
Suchetana Goswami, Subrata Saha
Department of Pedodontics and Preventive Dentistry, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
|Date of Web Publication||30-Jun-2017|
65/2 Shastri Road, Naihati, North 24 Parganas - 743 165, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Gingivitis is common in children which if neglected may progress to periodontitis in the adults. Therefore, early diagnosis of gingivitis and appropriate therapeutic measures in children are of utmost importance to prevent or minimize progression of periodontitis in the adult population.
Aims: The aim of this study was to determine the prevalence of gingivitis and periodontitis among preschool children in Kolkata.
Materials and Methods: A cross-sectional survey of 200 children aged 2–5 years were performed from March 2015 to February 2016. The gingival index (GI) and pocket depth of fully erupted teeth were measured.
Results: The comparison (t-test) of mean pocket depth was least (0.89 mm) between 3- and 4-year-old children and was highest (3.09 mm) between 2- and 4-year-old children. The mean GI among boys and girls differ significantly (P < 0.001). The boys had a higher GI and pocket depth than girls the mean GI in school going children was 0.67 ± 0.22 and in nonschool going children, it was 1.189 ± 0.12, and mean pocket depth was 2.05 ± 0.32 and 2.77 ± 0.55, respectively. The mean GI and pocket depth in children of upper and lower socioeconomic condition differ significantly.
Conclusion: Preschool children in and around Kolkata suffer from varying degree of gingival diseases, and comprehensive preventive programs are needed to improve their oral health.
Keywords: Gingival index; Kolkata; periodontal pocket depth; preschool children
|How to cite this article:|
Goswami S, Saha S. The prevalence of gingivitis and periodontal diseases in preschool children in Kolkata. Indian J Multidiscip Dent 2017;7:3-7
|How to cite this URL:|
Goswami S, Saha S. The prevalence of gingivitis and periodontal diseases in preschool children in Kolkata. Indian J Multidiscip Dent [serial online] 2017 [cited 2017 Aug 18];7:3-7. Available from: http://www.ijmdent.com/text.asp?2017/7/1/3/209272
| Introduction|| |
Epidemiological studies suggest that gingivitis is common in children and adolescent and untreated cases may progress to severe breakdown of periodontium and loss of teeth in the adult., Although the prevalence of destructive forms of periodontal diseases is lower in young individuals than in the adults, cases describing radiographic evidence of bone loss around primary dentition in children have been documented.,, It has been reported that chronic mild gingivitis characterized by the presence of gingival inflammation without detectable loss of bone is common in children. Early diagnosis of gingival diseases and appropriate therapeutic measures can ensure greater chances to prevent future periodontal diseases. Therefore, despite this low prevalence of attachment loss and periodontal diseases, the American Academy of Pediatric Dentistry has recommended that children should receive a periodic periodontal evaluation.
The distribution and severity of gingival disease vary within and between countries due to the differences in socioeconomic conditions and environmental factors.,,, For example, a Sri Lankan study reported bleeding gums in 47% of preschool children. Yam et al. studied the prevalence of gingivitis among preschool children (2–5 years) in Senegal and observed it in 42.86% of the children. Aranza and Peña showed a 39% prevalence of gingivitis among preschool children of 4 and 5 years old. Piazzini found gingivitis in 2%–34% in 2-year-old children and 18%–38% in 3-year-old children. In India, Kaur et al. observed that 67% of rural and 33% of urban children in the age group of 5 years were affected with gingivitis. The aim of this study was to determine the prevalence of gingivitis and periodontal diseases in preschool children in Kolkata.
| Materials and Methods|| |
The study was performed among 2–5-year-old preschool children in Kolkata. The study period was from March 2015 to February 2016. In this cross-sectional study, patients were selected using the stratified random sampling technique. A total of 200 children (91 boys and 109 girls) aged between 2 and 5 years who accompanied their parents were selected for this observational study. In this investigation, only the stable, fully erupted teeth were examined to assess the gingival condition. Furthermore, to avoid eruption gingivitis or inflammation associated with exfoliation process, teeth undergoing eruption or exfoliation were excluded from the study. Medically compromised children, children with physical and mental disability, children having systemic diseases and who were on antibacterial, anticholinergic, or other medications were excluded from the study.
Permission for this study was obtained from the Institutional Ethical Committee. Informed consent was obtained from the parents/accompanying caregivers. The children were examined in a well-illuminated area, whereas the child was seated in a dental chair. Instruments used for the present study were plastic disposable mouth mirrors and disposable explorers. The gingival surface was air-dried gently with oil free noncompressed air. Gingival conditions of preschool children were assessed using the criteria recommended by Nanda and Khurana. The indices used were gingival index (GI) and modified PMA Papillary marginal attached index.
Furthermore, erupting or exfoliating teeth were excluded. This helped to assess gingival health, uninfluenced by eruption gingivitis or inflammation associated with exfoliation process.
The data were collected and subjected to statistical analysis. Descriptive analyses including frequency, percentage, and proportions were performed. Where appropriate, the significance of the findings were evaluated using t-test. The level of significance was set at 5%.
| Results|| |
[Table 1] shows the distribution of samples according to the gender and age. The GI and probing depth increases with age. The highest mean GI and probing depth were found in the 5-year-old children [Table 2].
|Table 2: Gingival index and pocket depth according to age of the patients|
Click here to view
[Table 3] shows the comparison of mean GI and mean pocket depth between ages. The mean pocket depth was also significantly higher in nonschool going children [Table 4].
|Table 3: Comparison of mean gingival index and mean pocket depth between ages|
Click here to view
|Table 4: The comparison of gingival Index and pocket depth in school going and nonschool going children|
Click here to view
[Table 5] displays the distribution of GI and pocket depth based on three different socioeconomic conditions. It was found that mean pocket depth was more in children belonged to lower socioeconomic status.
|Table 5: The distribution of gingival index and pocket depth according to the socioeconomic condition|
Click here to view
[Table 6] shows the comparison of mean GIs and mean pocket depth of children belonging to upper, middle, and lower socioeconomic status.
|Table 6: Comparison of mean Gingival Indices and mean pocket depth of children belonging to upper, middle, and lower socioeconomic status by t-test|
Click here to view
It is evident that mean GI between boys and girls differ significantly (P < 0.001). The boys had higher GI and pocket depth than girls [Table 7].
|Table 7: The gender-wise distribution of mean gingival index and pocket depth|
Click here to view
[Table 7] shows the distribution of mean GI and pocket depth based on the gender of the children.
| Discussion|| |
Clinically, the gingival tissues in children are normally reddish due to the thinner epithelium and greater vascularity of connective tissue. In comparison with the adults, gingival margins are rounded, and sulcular depths are greater in children. Delany reported that probing the depth of gingival sulcus around primary teeth are approximately 2 mm with the facial and lingual probing depths shallower than proximal sulcus.
The gingival disease is considered the second most frequent alteration of oral mucosa affecting >75% of the population and the marginal gingivitis is the most common form of the gingival disease in children., Although the attachment loss is not common in young children the gingival inflammation in children and adolescents if not treated may progress to periodontitis.,
In this study, 53% of children had some degree of gingivitis. Yam et al. in their study observed gingivitis in approximately 43% of preschool children. Aranza and Peña found a 39% prevalence of gingivitis among children of 4 and 5 years old. A lower prevalence was reported by Piazzini, 2%–34% in 2 years of age and 18%–38% in 3-year-old children.
In this study, it is found that GI and probing depth increase with age. The highest mean GI and probing depth were found in 5-year-old children, which is in agreement with the hypothesis of De La Teja et al. who reported that gingivitis increases with age. They observed that at 7 years of age, the children had a GI of 0.67 (±0.2) (mild gingivitis) which increased to 1.10 (±0.4) in 12-year-old children indicating moderate gingivitis.
This study also reveals that GI and probing depth are significantly more (P < 0.001) in nonschool going children than in school going children. The mean pocket depth is also significantly higher in nonschool going children. The difference may be because the school going children undergo regular supervision by teachers. They are also exposed to different school health programs which may have influenced their oral health behavior.
In the present study, it was found that mean GI and pocket depth were lower in children of higher family income level. The study results are in agreement with the observations of Russell who also reported that gingival diseases are less common in children of higher family income. In an Indian study, Ramachandran et al. showed that the prevalence of periodontal disease in rural population was slightly greater than the urban population. In this study, higher GI score and more mean pocket depth were recorded in children belonged to lower socioeconomic status. This is consistent with the results of Sofola et al. who also reported that children from a low social class in the urban area had significantly poorer oral hygiene than those from higher family income.
Ketabi et al. observed that the level of mothers' education had a positive influence on the gingival health of the child. They found that the educated mothers can influence their child's attitude about oral hygiene procedures.
From this study, it is evident that mean GI among the boys and girls differ significantly (P < 0.001). The boys had a higher GI and pocket depth than the girls. This result corroborates with the result of Ketabi et al. who also reported that boys had a greater prevalence of gingivitis than girls. This finding is also in agreement with the results of Nanda and Khurana, Kelly and Sanchez  and Marshal et al. who showed a higher prevalence of gingival diseases in boys than in girls. Several studies have confirmed that oral hygiene negligence is the most important etiological factor in developing gingivitis in children and girls are probably more concerned about their oral cleanliness.,
The etiological role of dental plaque in the gingival and periodontal diseases is well established. Therefore, prevention of these diseases should be directed toward mechanical and chemotherapeutic plaque control and improvement of oral health. Udin advocated the implementation of preventive programs in infancy so that the process of healthy habits acquisition occur at the earliest possible date. Several investigators recommended parent participation in the preschool oral health program., These investigators have observed that parent education is related to the improvement in oral hygiene and gingivitis in children.
The limitations of this study include its cross-sectional nature and small sample size. More information regarding the children's dental visits, the number of siblings and frequency of brushing could have shown the relationship between oral health behavior family size and gingival diseases. In spite of that, our results show the prevalence of gingivitis and periodontal diseases in preschool children in Kolkata we hope that the results of our study might help the health care providers in oral health promotion for parents and caregivers, to further reinforce good oral habits and home care in preschool children.
| Conclusion|| |
It can thus be concluded that children in and around Kolkata suffer from varying degree of gingival diseases from their early childhood. A comprehensive and thorough preventive programs aiming at the improvement of gingival and oral health and proper nutritional care in preschool children should be implemented from the grass root level to ensure the happy and healthy smile in the future of our nation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Califano JV; American Academy of Periodontology – Research, Science and Therapy Committee; American Academy of Pediatric Dentistry. Periodontal diseases of children and adolescents. Pediatr Dent 2005-2006;27 7 Suppl:189-96.
Ketabi M, Tazhibi M, Mohebrasool S. The prevalence and risk factors of gingivitis among the children referred to Isfahan Islamic Azad University (Khorasgan branch) dental school, in Iran. Dent Res J 2006;3:31-34. Available from: http://www.drj.mui.ac.ir
.[Last accessed on 2016 May 30].
Valerie C, Susan K. Guidelines for Periodontal Screening and Management in Children and Adolescents Under 18 Years of Age, Guidelines Produced in Conjunction with British Society of Periodontology and British Society of Paediatric Dentistry; 2012. Available from: http://www.bsperio.org.uk
Matsson L, Hjersing K, Sjödin B. Periodontal conditions in Vietnamese immigrant children in Sweden. Swed Dent J 1995;19:73-81.
Matsson L, Sjödin B, Blomquist HK. Periodontal health in adopted children of Asian origin living in Sweden. Swed Dent J 1997;21:177-84.
Masiga MA. Socio-demographic characteristics and clinical features among patients attending a private paediatric dental clinic in Nairobi, Kenya. East Afr Med J 2004;81:577-82.
Dean JA, Avery DR, Mc Donald RE. Dentistry for the Child and Adolescent. 9th
ed. Missouri: Mosby; 2004. p. 415-8.
Nanayakkara V, Renzaho A, Oldenburg B, Ekanayake L. Ethnic and socio-economic disparities in oral health outcomes and quality of life among Sri Lankan preschoolers: A cross-sectional study. Int J Equity Health 2013;12:89.
Yam AA, Ba M, Faye M, Sane DD. Caries and gingivitis study among preschool children (2-5 years) of the region of Ziguinchor in Senegal. Strategies of prevention. Dakar Med 2000;45:180-4.
Aranza OT, Peña IT. Prevalence of gingivitis in preschool-age children living on the East side of Mexico City. Bol Med Hosp Infant Mex 2011;68:19-23.
Piazzini LF. Periodontal screening and recording (PSR) application in children and adolescent. J Clin Pediatr Dent 1994;18:165-71.
Kaur A, Gupta N, Baweja DK, Simratvir M. An epidemiological study to determine the prevalence and risk assessment of gingivitis in 5-, 12- and 15-year-old children of rural and urban area of Panchkula (Haryana). Indian J Dent Res 2014;25:294-9.
] [Full text]
Nanda RS, Khurana HS. Assessment of gingivitis in children. J Indian Dent Assoc 1969;41:315-9.
Massler M. The P-M-A index for the assessment of gingivitis. J Periodontol 1967;38:592-601.
Delaney JE. Periodontal and soft-tissue abnormalities. Dent Clin North Am 1995;39:837-50.
Jenkins WM, Papapanou PN. Epidemiology of periodontal disease in children and adolescents. Periodontol 2000 2001;26:16-32.
Chouhan VS, Chouhan RS, Devkar N, Vibhute A, More S. Gingival and periodontal diseases in children and adolescents. J Dent Allied Sci 2012;1:26-9.
Juárez-López ML, Munieta-Pruneda JF, Teodosio-Procopio E. Prevalence and risk factors for periodontal disease among preschool children in Mexico City. Gac Med Mex 2005;141:185-9.
De La Teja AE, Garcia-Dehesa DM, Lopez-Morteo VM, Gutiernez-Castrellon P, Morto-Soto M. Gingivitis in school level socioeconomic investigation. Acta Pediatr Mex 1999;20:280-3.
Russell AL. The prevalence of periodontal disease in different populations during the circumpubertal period. J Periodontol 1971;42:508-12.
Ramachandran K, Rajan BP, Shanmugam S. Epidemiological studies of dental disorders in Tamil Nadu population 1. Prevalance of dental caries and periodontal disease. J Indian Dent Assoc 1973;45:65-70.
Sofola OO, Shaba OP, Jeboda SO. Oral hygiene and periodontal treatment needs of urban school children compared with that of rural school children in Lagos State. Nigeria. Odontostomatol Trop 2003;26:25-9.
Kelly JE, Sanchez MJ. Periodontal disease and oral hygiene among children. United States. Vital Health Stat 11 1972;11:1-28.
Marshall-Day CD, Stephens RG, Quigley LF. Periodontal disease: Prevalence and incidence. J Periodontol 1955;26:185-203.
Caranza FA, Newman MG. Carranza's Clinical Periodontology. 9th
ed. Philadelphia: WB Saunders; 2002. p. 308.
Udin RD. Newer approaches to preventing dental caries in children. J Calif Dent Assoc 1999;27:843-51.
Axelsson P, Paulander J, Svärdström G, Tollskog G, Nordensten S. Integrated caries prevention: Effect of a needs-related preventive program on dental caries in children. County of Värmland, Sweden: Results after 12 years. Caries Res 1993;27 Suppl 1:83-94.
Rayner JA. A dental health education programme, including home visits, for nursery school children. Br Dent J 1992;172:57-62.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]