Journal of Indian Society of Periodontology
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Year : 2015  |  Volume : 19  |  Issue : 6  |  Page : 678-682  

Periodontal disease status and associated risk factors in patients attending a Dental Teaching Hospital in Rawalpindi, Pakistan

1 Department of Periodontology and Preventive Dental Sciences, Dental Section, University Medical and Dental College, Faisalabad, Pakistan
2 Department of Periodontology, Margalla College of Dentistry, Rawalpindi, Pakistan

Date of Web Publication28-Dec-2015

Correspondence Address:
Syed Akhtar Hussain Bokhari
No. 22-Rewaz Garden, Lahore
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-124X.156882

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Background: Investigators have identified an association of socio-demographic and medical factors with periodontal risk. This study observed status and association of periodontal disease and associated risk factors/indictors. Materials and Methods: All patients attending a dental teaching hospital were interviewed for socio-demographic and medical information through a structured questionnaire. Participants were examined for periodontal status using the community periodontal index (CPI), by a single examiner during September to November 2012. An association of age, gender, smoking habit, systemic conditions, and oral hygiene measures with periodontal status ([periodontitis CPI score ≥3]/nonperiodontitis [CPI score ≤2]) was analyzed by applying Chi-square test and forward selection stepwise regression analysis. Results: One thousand nine hundred and eighteen patients were examined during the study period. The findings revealed that 63.5% of the subjects had CPI score ≤2 (nonperiodontitis), while 34.5% were found with CPI score ≥3 (periodontitis). Age, gender, occupation, smoking, diabetes, arthritis, cardiovascular disease, kidney disease, stress, medications, and oral hygiene habits of using tooth powder or tooth brushing were significantly (P ≤ 0.037) associated with periodontal status. Regression analysis showed a significant association of age, occupation, and smoking with periodontitis. Conclusion: This study observed prevalence of periodontitis in one-fourth of study sample. The study confirmed various socio-demographic risk factors/indictors associated with increased risk of periodontitis.

Keywords: Community periodontal index, periodontal disease, prevalence, risk factors/indicators

How to cite this article:
Bokhari SA, Suhail AM, Malik AR, Imran MF. Periodontal disease status and associated risk factors in patients attending a Dental Teaching Hospital in Rawalpindi, Pakistan. J Indian Soc Periodontol 2015;19:678-82

How to cite this URL:
Bokhari SA, Suhail AM, Malik AR, Imran MF. Periodontal disease status and associated risk factors in patients attending a Dental Teaching Hospital in Rawalpindi, Pakistan. J Indian Soc Periodontol [serial online] 2015 [cited 2022 Aug 8];19:678-82. Available from:

   Introduction Top

Prevalence of the periodontal disease varies in different regions of the world, and a higher prevalence and severity of periodontal disease in Asian countries is reported.[1] Periodontal diseases are chronic infectious diseases that results in the inflammation of specialized tissues that surround and support the teeth. It can lead to a progressive loss of connective tissue attachment and alveolar bone. This tissue destruction is characterized by the formation of periodontal pockets that act as reservoirs for bacterial colonization of the dento-gingival environment.[2],[3] Periodontal diseases can be divided into two major categories: (a) Gingivitis – nondestructive and reversible gingival inflammation related to a nonspecific bacterial challenge; and (b) periodontitis – destructive inflammation of teeth supporting tissues (periodontal ligament, cementum, and alveolar bone) related to some specific periodontal pathogens.[4]

Many risk factors and risk indicators have been identified that are associated with increased risk of periodontal disease. Socio-demographic factors of age, sex, education, income, occupation, medical conditions such as diabetes, cardiovascular disease (CVD), arthritis, kidney disease, respiratory disease, stress and habits of smoking, tobacco use, alcohol, and oral hygiene practices have shown significant relationship with periodontal disease.[5],[6],[7] Majority of the population are suffering from moderate grade of periodontitis that initiates at an early age, and clinical manifestations of the disease appear after 35 years of age, which if left untreated will ultimately result in loss of tooth.[8] The identification of a relationship between periodontal disease and some systemic conditions or events can improve care and attention to systemic health, either as a preventive or therapeutic strategy. The prevalence of periodontal diseases varies in different regions of the world according to the definition of periodontitis and study population, and there are indications that they may be more prevalent in developing than in developed countries.[1],[9],[10],[11]

National oral health surveys have assessed periodontal health in America [12] and it was noted that 82% of adolescents in United States have overt gingivitis. The National Health and Nutrition Examination Survey III conducted during 1988–1994[11] have demonstrated that 50% of the adult population has gingival inflammation. The national survey also reported that 19.9% of subjects aged 30 years and 7.3% of those aged 90 years had a clinical attachment level ≥5 mm and 7 mm, respectively.

From a study in UK,[13] it was reported that moderate periodontal disease remains commonplace amongst UK adults and that the associated risk factors of plaque and calculus are in abundance, even among those who profess to be motivated about their oral health and attend the dentist regularly. The continued high prevalence of disease needs to be seen in the context of the far larger number of people who are now potentially at some risk, particularly in the older age groups.

National research on periodontal disease is scanty in Pakistan; however, national oral health survey [14] and few other studies provides some information on status of periodontal disease and report prevalence up to 98%[15],[16],[17] and showed 31% with advanced periodontitis. This study was designed to evaluate periodontal disease prevalence and observe demographic and other risk factors/indicators associated with periodontal disease in the general public of a city in Pakistan.

   Materials and Methods Top

Study sample and design

Periodontal patients of any age, gender, socioeconomic status attending Margalla Dental Teaching Hospital Rawalpindi, Pakistan during September–November 2012 were included in the study. 2435 patients were reported in the department during this period. 1918 patients who gave consent were observed during the study period. Participants were interviewed and examined for periodontal status. Demographic characteristics and known risk factors/indicators and periodontal status were noted on a Performa prepared for the study.

Oral examination

Community periodontal index (CPI) component of CPITN index [18] was used to assess periodontal status. The index teeth (11, 16, 17, 26, 27, 31, 36, 37, 46, and 47) were examined at mesial and distal proximal sites on buccal and lingual/palatal sides. CPI was applied in six sextants as per laid down criteria by WHO. Periodontitis was defined as a CPI ≥ “code 3,” which indicates that more than one site had a 3.5 mm pocket or larger in the index teeth. All study parameters were analyzed with respect to periodontitis (CPI scores ≥3) and nonperiodontitis (CPI scores ≤2).

Statistical analysis

Statistical analysis was performed using the Chi-squared test for comparison of periodontitis and nonperiodontitis patients, and forward selection regression analysis was applied to explore association among study variables. A P = 0.05 was considered statistically significant. Ethical approval for study conduction was obtained from the competent authority of the Margalla Teaching Dental Hospital, Rawalpindi, Pakistan.

   Results Top

Demographic/medical information of study participants are shown in [Table 1]. 67% were males, 86% nonsmokers, 97% or more without any systemic disease. Majority (36%) was from labor class, and 55% were from age group 21 to 40 years. [Table 2] presents the distribution of study subjects with CPI scores ≤2/≥3. Mean age of patients was 24.2 ± 9.8 years of nonperiodontitis and 37.5 ± 14.7 years of periodontitis group. The findings revealed that 64.5% of the subjects had CPI score ≤2 (nonperiodontitis), whereas 35.5% were found with CPI score ≥3 (periodontitis). Age, gender, occupation, smoking, diabetes, arthritis, CVD, kidney disease, stress, medications, tooth powder, and tooth brushing habit were significantly (P ≤ 0.037) associated with periodontal status. Forward stepwise regression analysis showed a significant association of periodontitis with age, occupation, and smoking [Table 3].
Table 1: Demographic/medical data of study participants

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Table 2: Status of CPI and risk factors/indicators associated with periodontitis

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Table 3: Forward stepwise regression analysis, using CPI scores ≤2 and ≥3 as dependent variables

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   Discussion Top

This study reports the periodontal status of the general population that visit a dental hospital for a self-perceived periodontal problem or on referral by a dentist. Prevalence of periodontal diseases is based on disease definition or diagnostic criteria. Majority of cross-sectional surveys to assess prevalence of periodontal disease have used CPI of CPITN for being simple, inexpensive, less time consuming;[8] therefore, we also used CPI component of the index to estimate prevalence of periodontal disease in sample population. More than half of the study population was middle-aged comparable with regional data;[19] subjects with CPI score ≤2 were four times higher in ≤20 year age-group whereas subjects aged 40 years and above were four times higher with CPI score ≥3. Among subjects with CPI score ≥3: Percentage of females, laborers was higher in their respective groups; smokers were six times higher; CVD patients were 4 times higher, patients with respiratory disease, kidney disease, stress, and arthritis were 2 times higher than the nonperiodontitis group. Although exhibiting a significant difference between periodontitis and nonperiodontitis groups, subjects using tooth powder and toothbrush were equal in all respective categories. The prevalence of periodontitis with 82% of aged 60 years and above in this study are comparable with the national survey that reports 93% prevalence in the same age group [14] and other studies conducted in Pakistan such as Chaudhry et al.[15] have reported prevalence of 98% with 31% with advanced periodontitis in army juniors aged 18–52 years that is concordant with the current study.

A same level of the prevalence of periodontitis has been reported from Bangladesh, Burkina Faso, Kenya, Libya, and Nepal.[20] The prevalence of periodontitis (34.5%) in the present study matches the prevalence (27%) reported by Joseph and Cherry [21] in Trivandrum, India and with another Asian study for 32.3% prevalence of periodontitis (CPI score ≥3).[22] The main reasons for matching of individuals may be the age of the population and oral hygiene habits. 90% of the population studied was using toothbrush once or more times daily, only 6% using occasionally and 11% not using a tooth brush. Participants above the age of 40 years had more periodontitis that is in agreement with other regional studies.[19],[23] Age has been shown to be a risk factor for periodontal disease. Age itself does not affect the periodontal status, but it is the cumulative effect of untreated disease reflecting the effect of the age on disease severity.[24] The extent and severity of periodontal diseases were shown to be different in different age groups and the general trend observed in the majority of the studies was increasing severity with increasing age.[12],[24],[25],[26],[27],[28] Aging is a natural process and changes are there in host immunity against disease process but if one can practice optimum oral hygiene, he or she can maintain teeth throughout life. Increasing severity may be because of the untreated cumulative effect of disease process over the period of time.

The significant difference of periodontal status was observed on the basis of gender for defined score categories that disagree with another study.[21] Our results demonstrated that quite a higher number of males were with score ≤2, which may be attributed to poor attitude toward oral health and smoking. Habits like smoking, pan with tobacco chewing was shown to be a significant risk factor for more prevalence of periodontal diseases.[29],[30],[31] Tobacco has been shown to affect gingival and periodontal diseases by several means like increased colonization of shallow periodontal pockets by periodontal pathogens and increased levels of periodontal pathogens in deep periodontal pockets. Smoking may alter neutrophil chemotaxis, phagocytosis and oxidative burst. It can also increase the secretion of tumor necrosis factor alpha, prostaglandin E2, neutrophil collagenase and elastase in gingival crevicular fluid.[32] The prevalence of periodontitis was also higher among smokers, in agreement with other studies [33] but not in tobacco users. The male to female ratio of patients with periodontitis (1.7:1) is in agreement with other studies.[19],[34],[35] Higher prevalence of nonperiodontitis and periodontitis in low-income category corresponds with one study [36] but differs with another study.[37]

Significant prevalence of periodontitis is reported to be associated with systemic conditions such as diabetes mellitus,[17],[38],[39] arthritis, CVD, respiratory diseases, kidney disease is in concordance with other studies [40],[41] and the current study has also confirmed this association.

Toothbrush and toothpaste used to maintain day to day oral hygiene and good oral hygiene status was found to be significantly correlated with better periodontal health [21],[42] and this notion was confirmed in the current study as the number of patients without tooth brushing habit showed more periodontal disease.

Regression analysis of the data of this study showed that with increasing age the odds of having periodontitis increased and aging is reported to be associated with an increased incidence of periodontal disease [43] however, it has been suggested that increased level of periodontal destruction observed with aging is the result of cumulative destruction rather than a result of increased rate of destruction. Current knowledge has shown that periodontitis does not present a linear progression and is not age dependent. Moreover, its distribution and severity are strongly influenced by host susceptibility and risk factors.[44]

Untreated chronic periodontitis is responsible for tooth loss in the majority of the cases. Foreseeing the bad effects of periodontal diseases on oral as well as general health, the prevention of these diseases should include in national health program and national oral health survey should be conducted to get meaningful data for different oral diseases and plan around preventive/curative measures. Further studies will likely be focused on understanding the relationships between different factors and also on the rapid and practical identification of at-risk individuals and will allow us to tailor therapy to more closely suit the needs of our patients as individuals and the achieve better result.

   Conclusion Top

As periodontal diseases and their management have been a major concern of research in dental sciences, this study provides an insight into a number of factors that significantly affect periodontal disease status and need to be addressed during periodontal management.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Corbet EF, Zee KY, Lo EC. Periodontal diseases in Asia and Oceania. Periodontol 2000 2002;29:122-52.  Back to cited text no. 1
Flemmig TF. Periodontitis. Ann Periodontol 1999;4:32-8.  Back to cited text no. 2
Shub A, Swain JR, Newnham JP. Periodontal disease and adverse pregnancy outcomes. J Matern Fetal Neonatal Med 2006;19:521-8.  Back to cited text no. 3
Armitage GC. Periodontal diseases: Diagnosis. Ann Periodontol 1996;1:37-215.  Back to cited text no. 4
Dietrich T, Jimenez M, Krall Kaye EA, Vokonas PS, Garcia RI. Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease. Circulation 2008;117:1668-74.  Back to cited text no. 5
Beck J, Garcia R, Heiss G, Vokonas PS, Offenbacher S. Periodontal disease and cardiovascular disease. J Periodontol 1996;67:1123-37.  Back to cited text no. 6
Wu T, Trevisan M, Genco RJ, Dorn JP, Falkner KL, Sempos CT. Periodontal disease and risk of cerebrovascular disease: The first national health and nutrition examination survey and its follow-up study. Arch Intern Med 2000;160:2749-55.  Back to cited text no. 7
Singh A, Agarwal V, Tuli A, Khattak BP. Prevalence of chronic periodontitis in Meerut: A cross-sectional survey. J Indian Soc Periodontol 2012;16:529-32.  Back to cited text no. 8
[PUBMED]  Medknow Journal  
Baelum V, Fejerskov O, Karring T. Oral hygiene, gingivitis and periodontal breakdown in adult Tanzanians. J Periodontal Res 1986;21:221-32.  Back to cited text no. 9
Kumar TS, Dagli RJ, Mathur A, Jain M, Balasubramanyam G, Prabu D, et al. Oral health status and practices of dentate Bhil adult tribes of southern Rajasthan, India. Int Dent J 2009;59:133-40.  Back to cited text no. 10
Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999;70:30-43.  Back to cited text no. 11
Albandar JM. Periodontal diseases in North America. Periodontol 2000 2002;29:31-69.  Back to cited text no. 12
Morris AJ, Steele J, White DA. The oral cleanliness and periodontal health of UK adults in 1998. Br Dent J 2001;191:186-92.  Back to cited text no. 13
Government of Pakistan. Ministry of Health/WHO. Pakistan: Situation Analysis of Oral Health Sector; 2003.  Back to cited text no. 14
Chaudhry MP, Babar Z, Akhtar F. Current status of periodontal disease in the junior ranks of Army Units at Rawalpindi. Pak Armed Forces Med J 2003;53:26-8.  Back to cited text no. 15
Ali M. Prevalence of periodontal disease among secondary school children (9-18 years). Ann Abbasi Shaheed Hosp Karachi Med Dent Coll 2004;9:521-3.  Back to cited text no. 16
Haseeb M, Khawaja KI, Ataullah K, Munir MB, Fatima A. Periodontal disease in type 2 diabetes mellitus. J Coll Physicians Surg Pak 2012;22:514-8.  Back to cited text no. 17
Ainamo J, Barmes D, Beagrie G, Cutress T, Martin J, Sardo-Infirri J. Development of the World Health Organization (WHO) community periodontal index of treatment needs (CPITN). Int Dent J 1982;32:281-91.  Back to cited text no. 18
Ababneh KT, Abu Hwaij ZM, Khader YS. Prevalence and risk indicators of gingivitis and periodontitis in a multi-centre study in North Jordan: A cross sectional study. BMC Oral Health 2012;12:1.  Back to cited text no. 19
Pilot T, Barmes DE, Leclercq MH, McCombie BJ, Sardo Infirri J. Periodontal conditions in adults, 35-44 years of age: An overview of CPITN data in the Who Global Oral Data Bank. Community Dent Oral Epidemiol 1986;14:310-2.  Back to cited text no. 20
Joseph PA, Cherry RT. Periodontal treatment needs in patients attending dental college hospital, Trivandrum. J Indian Soc Periodontol 1996;20:67-71.  Back to cited text no. 21
Han DH, Khang YH, Jung-Choi K, Lim S. Association between shift work and periodontal health in a representative sample of an Asian population. Scand J Work Environ Health 2013;39:559-67.  Back to cited text no. 22
Khader YS, Rice JC, Lefante JJ. Factors associated with periodontal diseases in a dental teaching clinic population in northern Jordan. J Periodontol 2003;74:1610-7.  Back to cited text no. 23
Kumar S, Dagli RJ, Chandrakant D, Prabu D, Suhas K. Periodontal status of green marble mine labourers in Kesariyaji, Rajasthan, India. Oral Health Prev Dent 2008;6:217-21.  Back to cited text no. 24
Vandana KL, Reddy MS. Assessment of periodontal status in dental fluorosis subjects using community periodontal index of treatment needs. Indian J Dent Res 2007;18:67-71.  Back to cited text no. 25
[PUBMED]  Medknow Journal  
Anuradha KP, Chadrashekar J, Ramesh N. Prevalence of periodontal disease in endemically flourosed areas of Davangere Taluk, India. Indian J Dent Res 2002;13:15-9.  Back to cited text no. 26
[PUBMED]  Medknow Journal  
Thomas S, Tandon S, Nair S. Effect of dental health education on the oral health status of a rural child population by involving target groups. J Indian Soc Pedod Prev Dent 2000;18:115-25.  Back to cited text no. 27
Bhowate RR, Borle SR, Chinchkhede DH, Gondhalekar RV. Dental health amongst 11-15-year-old children in Sevagram, Maharashtra. Indian J Dent Res 1994;5:65-8.  Back to cited text no. 28
[PUBMED]  Medknow Journal  
Parmar G, Sangwan P, Vashi P, Kulkarni P, Kumar S. Effect of chewing a mixture of areca nut and tobacco on periodontal tissues and oral hygiene status. J Oral Sci 2008;50:57-62.  Back to cited text no. 29
Sumanth S, Bhat KM, Bhat GS. Periodontal health status in pan chewers with or without the use of tobacco. Oral Health Prev Dent 2008;6:223-9.  Back to cited text no. 30
Christensen LB, Petersen PE, Bhambal A. Oral health and oral health behaviour among 11-13-year-olds in Bhopal, India. Community Dent Health 2003;20:153-8.  Back to cited text no. 31
Newman MG, Takei HH, Carranza FA. Clinical Periodontology. St Louis, Missouri 63043: WB Saunders Company; 2002. p. 245-52.  Back to cited text no. 32
Haffajee AD, Socransky SS. Relationship of cigarette smoking to attachment level profiles. J Clin Periodontol 2001;28:283-95.  Back to cited text no. 33
Albandar JM, Rams TE. Global epidemiology of periodontal diseases: An overview. Periodontol 2000 2002;29:7-10.  Back to cited text no. 34
Susin C, Dalla Vecchia CF, Oppermann RV, Haugejorden O, Albandar JM. Periodontal attachment loss in an urban population of Brazilian adults: Effect of demographic, behavioral, and environmental risk indicators. J Periodontol 2004;75:1033-41.  Back to cited text no. 35
Torrungruang K, Tamsailom S, Rojanasomsith K, Sutdhibhisal S, Nisapakultorn K, Vanichjakvong O, et al. Risk indicators of periodontal disease in older Thai adults. J Periodontol 2005;76:558-65.  Back to cited text no. 36
Teng HC, Lee CH, Hung HC, Tsai CC, Chang YY, Yang YH, et al. Lifestyle and psychosocial factors associated with chronic periodontitis in Taiwanese adults. J Periodontol 2003;74:1169-75.  Back to cited text no. 37
Apoorva SM, Sridhar N, Suchetha A. Prevalence and severity of periodontal disease in type 2 diabetes mellitus (non-insulin-dependent diabetes mellitus) patients in Bangalore city: An epidemiological study. J Indian Soc Periodontol 2013;17:25-9.  Back to cited text no. 38
[PUBMED]  Medknow Journal  
Deshpande K, Jain A, Sharma R, Prashar S, Jain R. Diabetes and periodontitis. J Indian Soc Periodontol 2010;14:207-12.  Back to cited text no. 39
[PUBMED]  Medknow Journal  
Ranade SB, Doiphode S. Is there a relationship between periodontitis and rheumatoid arthritis? J Indian Soc Periodontol 2012;16:22-7.  Back to cited text no. 40
[PUBMED]  Medknow Journal  
Jain A, Kabi D. Severe periodontitis associated with chronic kidney disease. J Indian Soc Periodontol 2013;17:128-30.  Back to cited text no. 41
[PUBMED]  Medknow Journal  
Shah N, Sundaram KR. Impact of socio-demographic variables, oral hygiene practices and oral habits on periodontal health status of Indian elderly: A community-based study. Indian J Dent Res 2003;14:289-97.  Back to cited text no. 42
Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG, Machtei EE, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J Periodontol 1994;65:260-7.  Back to cited text no. 43
Costa FO, Susin C, Cortelli JR, Almeida Pordeus I. Epidemiology of periodontal disease. Int J Dent 2012;2012:848641.  Back to cited text no. 44


  [Table 1], [Table 2], [Table 3]

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