|Year : 2012 | Volume
| Issue : 2 | Page : 65-69
Prevalence of gingivitis and periodontitis in an adult male population in Nigeria
Agnes O Umoh, Clement C Azodo
Department of Periodontics, University of Benin, Benin City, Nigeria
|Date of Web Publication||12-Mar-2013|
Clement C Azodo
Room 21, 2nd Floor, Department of Periodontics, Prof Ejide Dental Complex, University of Benin Teaching Hospital, P.M.B. 1111 Ugbowo, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Objective: To determine the prevalence of gingivitis and periodontitis among an adult male population in Benin City, Nigeria. Materials and Methods: The drivers of a private motor transport company whose head office is in Benin City constituted the study participants. Data collection was through an interview-administered questionnaire and periodontal examination. Periodontal disease was assessed using community periodontal index while demographic characteristics, social habits and oral hygiene habits were elicited using interview-administered questionnaire. Results: The prevalence of gingivitis and periodontitis was 75.4% and 15.4% respectively. The prevalence of periodontitis was higher among older participants, those of lower educational attainment and longer driving experience, those that indulged in only once-daily teeth cleaning, tobacco users, regular alcohol and kolanut consumers. Conclusion: The prevalence of gingivitis and periodontitis in this study was similar to previous reports in Nigeria. The prevalence was higher in relation to the risk factors considered in this study thereby necessitating the need for an awareness campaign to enlighten the public about the harmful effects of tobacco, kolanut and alcohol on periodontal health. This study is also recommended among a larger number of people.
Keywords: Drivers, gingivitis, male, periodontal disease, periodontitis
|How to cite this article:|
Umoh AO, Azodo CC. Prevalence of gingivitis and periodontitis in an adult male population in Nigeria. Niger J Basic Clin Sci 2012;9:65-9
|How to cite this URL:|
Umoh AO, Azodo CC. Prevalence of gingivitis and periodontitis in an adult male population in Nigeria. Niger J Basic Clin Sci [serial online] 2012 [cited 2019 May 23];9:65-9. Available from: http://www.njbcs.net/text.asp?2012/9/2/65/108465
| Introduction|| |
Periodontal disease is broadly categorized as gingivitis and periodontitis with gingivitis being an earlier reversible form of periodontal disease in which inflammation is confined to the gingiva without destruction of the supporting tissues while periodontitis is the irreversible destruction of the deeper structures of the periodontium with resultant connective tissue attachment and alveolar bone loss, periodontal pocket, tooth mobility and eventual tooth loss. 
The prevalence of periodontal disease in the African population is quite high and has been described as 'a grave socio-economic problem in Black Africa'.  It is the most frequent oral disease, second only to dental caries and a significant cause of tooth mortality among adults qualifying it as a significant oral health issue in Nigeria. , The occurrence of periodontal disease has been associated with factors such as low socio-economic status, poor access to healthcare services and other health-related risk behaviors such as smoking, alcohol intake, carbohydrate-rich diets and inadequate oral hygiene which are dominant in developing countries. ,
The information on the prevalence and determinants of periodontal disease will form the basis of developing preventive and interventional programs geared towards prevention, restoration and amelioration among individuals suffering from this condition. However, the studies on the periodontal health of Nigerians available in the literature were conducted either on specific age groups like school children , and the elderly , or utilized a hospital-based participant recruitment system as in the national  and rural-urban  survey in Benin City, thereby giving incomplete information about periodontal disease among adults in Nigeria. The few community-based studies like the study among Nigerian factory workers in Lagos State laid emphasis on the effect of tobacco use on periodontal health.  Therefore, additional community-based studies on the prevalence and determinants of periodontal diseases among adults, especially among high-risk groups like professional drivers are deemed necessary. Although indices for the assessment of periodontal status like periodontal disease index and periodontal index exist, Community Periodontal Index of Treatment Needs (CPITN) is the accepted index for assessment of periodontal status in epidemiological studies worldwide.  The name was subsequently changed to Community Periodontal Index (CPI) to denote its use as an epidemiological tool. The objective of the study was to assess the prevalence of gingivitis and periodontitis among male professional drivers in Nigeria.
| Materials and Methods|| |
The study participants were the drivers of a private motor transport company with branches across Nigeria and head office in Benin City, Edo State, Nigeria. This study was carried out with the informed consent and understanding of the 65 participants recruited into the study. A structured interview-administered questionnaire was completed for each participant by 2 periodontologists. It included information on demographic characteristics, social habits, and oral hygiene habits. For each participant, periodontal examination using community periodontal index CPI was performed by the periodontologists using a sterilized CPI probe and mouth mirror, under artificial illumination provided by fluorescent light and pen torch, in a temporarily created clinic in the motor park. Face mask and examination gloves were worn by the examiner to prevent cross-infection. The calibration of the two examiners was done on three different occasion using 10 patients. The measurements were subjected to Cohen's Kappa statistics and intra-class correlation coefficient for inter-examiner and intra-examiner reliability giving value of 0.8 and 1.0 respectively. The indexed teeth in each sextant were examined by running the CPI probe around the whole circumference of the tooth and pocket depths were measured at six sites per tooth (mesio-, mid-, and disto-buccal; mesio-, mid-, and disto-lingual/palatal).
Assessing with the CPI, the participants were categorized thus; Code 0 = healthy periodontium, codes 1 and 2 = gingivitis and codes 3 and 4 = periodontitis. Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS Version 17.0). Categorical variables were described using frequencies and percentages. Test of association was done with chi square and Fischer's exact test where applicable. P < 0.05 was considered statistically significant.
| Results|| |
A total of 65 drivers out of 90 drivers employed by the private transport company which represented 72.2% of the population were studied. The age distribution of the participants was between 25 to 64 years cutting across young adulthood, middle adulthood to the elderly. Those participants aged 45-64 years constituted 41 (63.1%) of the participants. About half (32, 49.2%) had attained primary education and 57 (87.7%) had more than 10 years' driving experience.
A total of 6 (9.2%), 49 (75.4%) and 10 (15.4%) of the participants had normal periodontium, gingivitis and periodontitis respectively. The relationship between age distribution and periodontal health showed that the older age group had more gingivitis and periodontitis than their younger counterparts. Participants with lower level of education had higher prevalence of gingivitis and periodontitis. The driving experience of participants in relationship to the periodontal health revealed that those with more than 10 years' driving experience had a higher prevalence of gingivitis (43, 75.4%) and of periodontitis (9, 15.8%) [Table 1].
|Table 1: Relationship between demographic characteristics and periodontal health among the participants|
Click here to view
About two-thirds (43, 66.2%) of the participants cleaned their teeth once daily while 22 (33.8%) cleaned them more than once daily. Of the participants, 24 (36.9%) were tobacco users while 41 (63.1%) were non-tobacco users. In terms of alcohol consumption, 7 (10.8%) were non-consumers, 52 (80.0%) and 6 (9.2%) were irregular and regular consumers respectively. A total of 38 (58.5%), 25 (38.5%) and 2 (3.1%) of the participants were non, irregular and regular kolanut consumers respectively.
Participants who engaged in once-daily tooth cleaning were more likely to have periodontitis in comparison with their counterparts in this study. Tobacco users had more periodontitis and less gingivitis than non-users. The regular alcohol and kolanut consumers were more likely to have periodontitis than non-consumers [Table 2].
|Table 2: Relationship between daily tooth cleaning frequency, social habits and periodontal health among participants|
Click here to view
Once-daily tooth cleaning frequency was more among younger participants, those with lower educational attainment and having greater than 10 years' driving experience. Regular alcohol and kolanut consumers were older participants, those with lower educational attainment and less or equal to 10 years' driving experience. Tobacco use was more among younger participants, those with higher educational attainment and fewer years of driving experience [Table 3].
|Table 3: Relationship between demographic characteristics, daily tooth cleaning frequency and social habits among the participants|
Click here to view
| Discussion|| |
In this study, the prevalence of periodontal diseases was 90.8% [gingivitis (75.4%) and periodontitis (15.4%)] which is significantly high. This may be hinged on the fact that most of the participants were middle-aged adults and the elderly who are more susceptible to periodontal diseases. This also reflected the vulnerability of the participants due to their tooth cleaning frequency, social habits and educational attainment. However, amongst the participants with periodontal disease, the majority (75.4%) had gingivitis while a few (15.4%) had periodontitis. The prevalence of periodontitis (15.4%) in this study is within the previous reported prevalence (15-57%) of periodontitis in Nigeria.  This pattern of periodontal disease in this study pointed to the fact that intervention will lead to total restoration of periodontal health halting progression to destructive periodontitis in the majority of the participants because gingivitis is known to be reversible with adequate care. The higher prevalence of gingivitis and lesser prevalence of periodontitis among the participants in this study could be a result of the fibrous nature of Nigerian diets which may have facilitated the development of resistance to the micro-organisms thereby halting the progression of the disease to periodontitis. 
In this study, the prevalence of gingivitis, periodontitis, and cumulative periodontal disease was slightly higher among the older age group, reflecting periodontal disease as a disease of lifetime accumulation. The decline in immune and healing potential with aging impairs host response to disease thereby increasing the prevalence of periodontal disease among older individuals. The slight difference in the prevalence of periodontal disease noted in this study between the older and younger age groups may be explained by the negligible difference in tooth cleaning frequency and periodontal disease risk behavior among older participants than younger participants.
Studies have documented a higher prevalence of periodontal disease in individuals with lower educational attainment. ,,, In this study, participants with lower level of education had higher prevalence of gingivitis (78.1% versus 72.7%) and periodontitis (21.9% versus 9.1%). The explanation in the difference lies in the fact that individuals of lower educational attainment were more regular alcohol and kolanut consumers and indulged in less frequent daily tooth cleaning. There was a higher (16.3%) prevalence of periodontitis among participants who indulged in once-daily teeth cleaning than those who indulged in more frequent daily teeth cleaning (13.6%). Lower educational attainment has been associated with poor periodontal health awareness and irregular oral self-care practices culminating in higher levels of dental plaque which is the primary etiological factor for development of periodontal disease. 
The driving experience of participants in relationship to the periodontal health revealed that those with more than 10 years' driving experience had a higher prevalence of gingivitis (75.4%), periodontitis (15.8%) and overall periodontal disease (91.2%). The difference may be explained by the fact that more experienced drivers were regular kolanut consumers and more likely to clean their teeth less frequently daily.
The prevalence of periodontitis among participants who were alcohol and kolanut consumers was higher than that in their non-consuming counterparts. The indulgence in these habits tends to result in poor self-care, eventually resulting in periodontal disease. Tobacco users were more likely to have periodontitis in comparison to non-tobacco users in this study. The adverse effect of nicotine on gingival blood flow, cytokine production, neutrophil and other immune cell function, and connective tissue turnover are some of the mechanisms responsible for overall effects of tobacco on periodontal tissues.  The lower concern about health noted among smokers also contributes to a higher prevalence of periodontitis among them.  Tobacco users were also less likely to have gingivitis in comparison to non-tobacco users in this study. The suppressed gingival bleeding response to plaque explains the lesser tendencies to gingival bleeding of gingivitis among smokers than non-smokers in the presence of a similar plaque index. 
| Conclusion|| |
The prevalence of gingivitis and periodontitis in this study was similar to previous reports in Nigeria. The prevalence was higher in relation to the risk factors considered in this study, thereby necessitating the need for awareness campaigns to enlighten the public about the harmful effects of tobacco, kolanut and alcohol on periodontal health. This study is also recommended among a larger number of people.
| References|| |
|1.||American Academy of Periodontology-Research, Science, and Therapy Committee; American Academy of Pediatric Dentistry. Treatment of plaque-induced gingivitis, chronic periodontitis, and other clinical conditions. Pediatr Dent 2005-2006;27 (7 Suppl):202-11. |
|2.||Grappin G, Lancour M. Periodontal disease; a grave socio-economic problem in black Africa. Odontostomatol Trop 1978;11:7-28. |
|3.||Aderinokun GA, Dosumu OO. Causes of tooth mortality in a Nigerian Urban Centre. Odontostomatol Trop 1997;79:6-8. |
|4.||Danielson OE, Chinedu AC, Oluyemisi EA, Bashiru BO, Ndubuisi OO. Frequency, causes and pattern of adult tooth extraction in a Nigerian rural health facility. Odontostomatol Trop 2011;34:5-10. |
|5.||Gugushe TS. The influence of socio-economic variables on the prevalence of periodontal disease in South Africa. SADJ 1998;53:41-6. |
|6.||Cruz SS, Costa Mda C, Gomes Filho IS, Vianna MI, Santos CT. Maternal periodontal disease as a factor associated with low birth weight. Rev Saude Publica 2005;39:782-7. |
|7.||Umesi D, Savage KO. Periodontal status of 12 years old Nigerians children in Lagos Mainland Government. J Community Med Prim Health Care 1997;9:69-78. |
|8.||Kolawole KA, Oziegbe EO, Bamise CT. Oral hygiene measures and the periodontal status of school children. Int J Dent Hyg 2011;9:143-8. |
|9.||Savage KO. A preliminary study of the periodontal status and treatment needs of elderly Nigerian subjects. Afr Dent J 1992;6:23-9. |
|10.||Okeigbemen SA, Jeboda SO, Umweni AA. A preliminary assessment of the periodontal status of elderly pensioners in Benin City, Nigeria. Gerodontology 2012;29:e1244-8. |
|11.||Adegbembo AO, El-Nadeef Ma, Adeyinka A. National study of periodontal status and treatment needs among Nigerians. Int Dent J 1995;45:197-203. |
|12.||AkhionbareO, Ojehanon PI, Ufomata DO, Jeboda SO. Periodontal treatment needs of urban and rural populations in Edo State, Nigeria. Niger Dent J 2007;15:13-7. |
|13.||Savage KO. Assessment of periodontal status of Nigerian factory workers in relation to cigarette smoking in Lagos. Nig Q J Hosp Med 1999;9:198-201. |
|14.||WHO. Oral health surveys: Basic methods. 3 rd ed. Geneva: World Health Organisation; 1987. p. 31-2. |
|15.||Akpata ES. Oral health in Nigeria. Int Dent J 2004;54 (6 Suppl 1):361-6. |
|16.||Kubota K, Watanabe H, Hollist NO, Ajayi-Obe SO, Ono Y, Ohnishi M, et al. Dental survey in Nigeria. Part 4. Prevalence and severity of periodontal diseases. Bull Tokyo Med Dent Univ 1988;35:11-7. |
|17.||Paulander J, Axelsson P, Lindhe J. Association between level of education and oral health status in 35-, 50-, 65- and 75-year-olds. J Clin Periodontol 2003;30:697-704. |
|18.||Gundala R, Chava VK. Effect of lifestyle, education and socioeconomic status on periodontal health. Contemp Clin Dent 2010;1:23-6. |
|19.||Boillot A, El Halabi B, Batty GD, Rangé H, Czernichow S, Bouchard P. Education as a predictor of chronic periodontitis: A systematic review with meta-analysis population-based studies. PLoS One 2011;6:e21508-15. |
|20.||Borrell LN, Beck JD, Heiss G. Socioeconomic disadvantage and periodontal disease: The Dental Atherosclerosis Risk in Communities study. Am J Public Health 2006;96:332-9. |
|21.||Caton JG, Quiñones CR. Etiology of periodontal diseases. Curr Opin Dent 1991;1:17-28. |
|22.||Malhotra R, Kapoor A, Grover V, Kaushal S. Nicotine and periodontal tissues. J Indian Soc Periodontol 2010;14:72-9. |
|23.||Ide R, Hoshuyama T, Wilson D, Takahashi K, Higashi T. The effects of smoking on dental care utilization and its costs in Japan. J Dent Res 2009;88:66-70. |
|24.||Natto SB. Tobacco smoking and periodontal health in a Saudi Arabian population. Swed Dent J Suppl 2005;(176):8-52. |
[Table 1], [Table 2], [Table 3]