This document summarizes the epidemiology of periodontal diseases globally and in India based on numerous studies. Key findings include: - Gingivitis and mild to moderate periodontitis are highly prevalent worldwide, especially in developing countries and among older age groups. - In India, studies show gingivitis is nearly universal among schoolchildren and adults. The prevalence and severity of periodontitis increases with age. - The National Oral Health Survey of India found over 50% of 12-year-olds had periodontal disease, increasing to nearly 90% among 35-44 year olds. Loss of attachment also increased significantly with age.

1. EPIDEMIOLOGY OF
PERIODONTAL DISEASES
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2. • Introduction
• Periodontal disease
• Epidemiology
- Distribution of periodontal disease
- World
- India
- Determinants of periodontal disease
- Host
- Agent
- Environment
• Changing trends of periodontal disease
• Conclusion

3. Introduction
• Periodontal disease - chronic oral diseases.
• History
• Christian era-pdl bone loss

4. Periodontal Disease
• Is one which attacks the supporting
structures of the teeth.

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6. Gingivitis
Periodontitis
Marginal Periodontitis
/ Schmutz Pyrrohea
Periodontosis / Juvenile
Periodontitis / Diffuse
alveolar atrophy
Atrophy

7. Two distinct types of periodontitis
• Plaque and local factors
• Compromised host type
Offenbacher S et al 1994

8. Classification
• Workshop 1999 (Armitage GC 1999)

9. Models of periodontal diseases
• Old view – 1961 – WHO
all equally susceptible
gingivitis periodontitis
• Research 1980-1990 – challenges
- no difference in prevalence between low-
income and high income countries
- repair

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11. • Burst Theory of periodontitis (Socransky SS et al
1984)
short acute bursts of rapid tissue destruction
followed by some tissue repair and long periods
of remission
• New Paradigm- modifying factors have
more role
• Periodontal medicine

14. Epidemiology
The study of distribution and determinants of
disease frequency in man.

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16. Uses of epidemiology in study of periodontal
diseases
• To study historically rise and fall of disease
• To diagnose community problems of health and disease by
study and analysis of incidence, prevalence and morbidity
• To estimate individuals risk and chances of developing
disease
• To help complete the clinical picture and natural history of
disease by group analysis

17. • To identify clinical syndromes by observation of
group behavior
• To evaluate need and effectiveness of health
services
• To search for causes of disease and of health by
observation of group habits, customs and
models of life.

18. • Work upon it has been retarded by a number of factors.
• Greatest incidence late in life
• Difficulty in objective measurement.
- Gingivitis - subjective & vague
- Pocket depth - observational errors
- Alveolar bone loss - cannot be evaluated clinically
• Quantitative studies – poor & unstandardized.
- Seldom possible to compare one investigator work
with another.

19. WORLD

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21. Gingivitis
• At population level, found in early childhood, is
more prevalent and severe in adolescence – then
level off.
• Ubiquitious in children and adults
- 82% US adolescents – overt gingivitis and signs
of gingival bleeding
- 75% of adults – gingival bleeding, dental calculus
and poor oral hygiene
• Similar in other parts of world

22. Chronic periodontitis (Non aggressive
form of Periodontitis)
• Most prevalent among adults and seniors
• Children and adolescents – wide range of
frequency in various geographic regions and
racial / ethnic groups
• Relatively high frequency in Africa and Latin
America
• Low disease frequency – young Caucasians in
Western Europe and North America

23. • 11-25 years age group
Prevalence
1-3% Western Europe
2-5 % North America
4-8% South America
5-8% Asia
10-20% Africa
Racial/ ethnic
1-3% Caucasians
5-8% Asians
5-10% Hispanics and Latin Americans
8-20% Africans and African Americans

24. North America
United States of America
• Health Examination Survey (1960-62)
- 18-79 yr
- 48.5 % - gingivitis
- 25.4 % - periodontal pockets
- 1.13 – PI per person

25. • NHANES –I (1971-74)
- 6-74 yr
- 25% - gingivitis ; 4.5% - 1-3 mm pocket ; 12.1% - >4mm
- 0.83 – PI per person
• NIDR (1985-86)
- 18-64 yr
- 44% - > 1 site bleeding ; 13.4 % - >1 site pockets 4-6mm ;
43.8 % - AL >3 mm
• NHANES – III (1988-94)
- 13 & older
- 54 % BOP ; 21 % - pockets > 4mm ; 38.1 % AL > 3mm.

26. Canada
• Broduer JM et al (2001)
- Quebec, 35-44 yr ; 2110
- 45.6 % - > 4mm pocket ; 8.5% - > 6mm pocket
- 81 % gingival bleeding
• Locker et al (1998)
- Ontario, 13-15 yr ; 721
- Dental calculus – 44.6 % Canadian born ;
- 72.9 % immigrants.

27. Europe
• Higher % age of adults have moderate probing
depth and mild-moderate periodontal attachment
loss
13-54% of 35-44 year old - 3.5 -5.5 mm pocket
Sheiham A et al 2002
• > 3.5 mm attachment loss
42% 35-44 year old
70% 55-64 year old
Morris AJ et al 2001

28. • Increase prevalence of periodontal disease –
Western Europe as compared to Eastern Europe
• 35-44 yr
- Shallow pockets
- East Europe – 45%
- West Europe – 36 %
- Deep pockets
- East Europe – 30 %
- West Europe – 10 %

29. Central And South America
• Credible data scarce
38%-67% - moderate or advanced periodontitis
28-52% Moderate disease
4-19% Severe disease
Gjermo P et al 2002
• Southern Brazil 30 years and older
> 5 mm attachment loss 79%
> 7 mm attachment loss 52%

30. • Poor oral hygiene
• Dental calculus
• Periodontitis widespread among older age
groups- 70-100% - > 50 years - moderate
and chronic periodontitis
Susin S et al 2004

31. Africa
• Poor oral hygiene
• Abundant calculus
• High prevalence of moderate probing depth and attachment
loss
• 30 years and older
> 4 mm attachment loss
44%-84% Uganda
79-98% Tanzania
91-99% Kenya
Baelum V et al 2002

32. Asia and Oceania
• 80-100% - calculus
• Low and lower middle income countries
shallow probing depth deep pockets
< 25 years 0-20% < 2%
> 60years 67% 20-30%

33. • Increase prevalence of gingival bleeding, dental
calculus, low prevalence of healthy periodontal
status irrespective of age cohort or country level
of development
• Difference is Less marked in seniors

34. Early-onset aggressive periodontitis
• Age group 11-25 years
Prevalence
Western Europe 0.1-0.5%
North America 0.4-0.8%
South America 0.3-1%
Asia 0.4-1%
Africa 0.5-5%
Racial/ ethnic
Caucasians 0.1-0.2%
Asians 0.4-1%
Hispanics and Latin Americans 0.5-1%
Africans and African Americans 1-3%

35. Gingival recession
• USA
> 3mm recession – 35% 30-90 year old
75% 65-90 year old
> 5 mm recession 23% 65-90 year old

36. WHO/CAPP- WHO Oral Health Country/Area Profile Programme
http://www.whocollab.od.mah.se/index.html

37. INDIA

38. Among School Children
• Marshall-Day & Tandon (1940)
- 756 middle class children, Lahore
- 13 yrs. – 68. 6 % - gingivitis
• Marshall-Day & Shourie (1944)
- 613 – low & middle class
- 5-15 yrs – 80 % - gingivitis

39. • Greene (1960)
- 1613 – low socioeconomic strata
- 11-17 yrs – 96.3 % gingivitis;
1.3 % with bone resorption.
• Ramfjord (1960)
- 827- Bombay
- 11- 17 yr. – 100 % - gingivitis
- Urban – PDI – 1.42
- Rural – PDI – 2.41.

40. • Shick (1960)
- 807 – Low middle class
- 5-19 yr. – 74.59 % gingivitis.
• Dutta A (1965)
- 1424 children – Calcutta
- 6-12 yrs – 73.4 % - in 6 yr ;
96.5 % - 12 yr
- Boys (91.6 %) > girls (87.6%)

41. • Tewari et al (1979)
- 1511 – Chandigarh
- 6-16 yr – 92.46 % - periodontal disease.
• Nagaraj Rao et al (1980)
- 500, Udupi
- 28 % - marginal gingivitis
- 7.2 % - chronic generalized gingivitis.
• Srivastava RP (1989)
- 690, Jhansi
- 6-8 yr – 42% ; 15-17 yr – 94.02%.

42. • Rao SP et al 1993
- Wardha 2 urban, 2 rural and 2 tribal primary
schools
- 60.8 % Manjan
- Pdl disease higher in tribal
• Goel P et al 2000
- Puttur municipality
- 5-6 years old and 12-13 years old
- 200 in each group
- 5-6 years old – no calculus
- 47.78% - 12-13 years – calculus

43. • Christensen LB et al 2003
- 11-13 years old, Bhopal, 599
- 15 % healthy gingiva
- 91% rural children – CPI score 2(Calculus)

44. Adult Population
• Marshall-Day & Shourie (1940) - 60 %- Punjab and
north India.
• Mehta et al (1953)
- 2219 males ; 18-55 yr ; Bombay & Ratnagiri
- Non-vegetarians ; Low SES
- Incidence is high among Indians
- Severity - with age
- Papillae and margins – do not show difference
- upper and lower involvement – same.

45. • Greene (1960)
- 1613 males India ; 577 males Atlanta
- 18 - 30 yr – 63 males – rural India
- highly prevalent in both groups – Indian
- Rural – more severe periodontal disease.
• Gupta et al (1962)
- 800 ; Trivandrum ; 11-50 yr
- 100 % after 30 yr.
- 90 % - 11-30 yr.

46. • Ramachandran et al (1973)
- 6647-rural ; 1536-urban – Tamil Nadu
- 95.3% & 95.5% respectively.
• Shetty & Gururaja Rao (1987)
- 2510 ;17-60 yr ; urban & rural areas – South
Canara.
- 31.3 % -periodontitis ; 67.13% - Chronic
gingivitis
- rural more than urban.

47. • Anil S et al (1990)
- 15-44 yr ; Trivandrum
- 15-19 yr – 86% - calculus & bleeding
- 25-29 yr – 80% - shallow pocketing
- 35-44 yr – 33% - pockets > 6mm.
• Maity AK et al (1994)
- 15-65 years old; Rural , Tamil Nadu
- CPITN
- Deep pockets – 2-3 subjects
- calculus - widespread

48. • Kurian M et al (1996)
- 1513 ; 15 yr ; Hebri
- 0.4 % - healthy periodontium
- 1.6 % - Bleeding on probing
- 26.6 % - Shallow pockets
- 24.1 % - deep pockets
• Jagdeesan M et al (2000)
- 1100; Women ; > 15 years, Rural, Pondicherry
- < 30 years – 15.8%
- > 30 years – 73.9%

49. • Doifode V et al (2000)
- Field practice area, Bapunagar, Nagpur
- 5061 residents
- 34.8% - periodontal disease
• Srikanth G et al (2000)
- fishermen community, Malpe, Udupi
- 300; 15 years and older
- 91% - periodontal disease

50. • Rao A (1999)
- institutionalized; > 60 years, Mangalore
- 300
- calculus – 21.88%; shallow pockets – 32.29%
- Deep pockets – 15.1%
• Shah N and Sundaram KR 2004
1240 elderly > 60 years South Delhi
CPITN
Bleeding on probing 7.4%
Calculus 1.7%
Shallow pockets 19%
Deep pockets 71.9%

51. Handicapped Children
• Mehrotra AK et al (1982)
- 61-physically handicapped - 88.5 %
- 66- mentally retarded individuals -100%
• Tandon S & Sudha P (1986)
- 40 handicapped children
- 8-18 yrs – showed poorer oral hygiene as
compared to normal.

52. • Vyas & Damle (1991)
- 466, 11-14 yr
- 100% - mentally subnormal
- 95.95 % - juvenile delinquents
- 97.38 % - physically handicapped
• Bhavsar JP and Damle SG 1995
- 593, 12-14 years old, Bombay
- Bleeding and calculus component high

53. Pregnant Women
• Samanth Asha (1976) - Chandigarh
- 40 – in each trimester
- 40 non-pregnant
- Mean gingivitis - Pregnant women
- maximum change – 2nd
trimester
• Dixit J et al (1980)
- 80 pregnant 40 non-pregnant women.
- severity of gingivitis in pregnant subjects.

54. • Sequeira PS (1991)
- 170 pregnant women
- 7.6 %
- No significant differences in different
trimesters

55. Juvenile Periodontitis
• Marshall-day & Shourie (1949)
- 568, 9-60 years , 35%
• Miglani & Sharma (1965)
- Madras, 0.1%
• Tewari and Rao SS (1968)
- 1200, 6.83%
- Western and Northern part, Vegetarians

56. NatioNal oral HealtH
Survey

57. Percent of subjects with
Periodontal disease in India by age
57% 67.70%
89.60% 79.90%
0%
50%
100%
12 yrs 15 yrs 35-44 yrs 65-74 yrs
3-D Line 1

58. Mean no. of sextants with periodontal
disease by age in India
2.9
4.5
2.9
2
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
12 years 15 years 35-44 years 65-74 years

59. Percent of subjects with loss of
attachment by age in India
7%
41.20%
60.70%
0%
10%
20%
30%
40%
50%
60%
70%
15 yrs 35-44 yrs 65-74 yrs

60. Mean no. of Sextants with loss of
attachment by age in India
1.61.3
0.2
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
15 years 35-44 years 65-74 years

61. Periodontal Status in Karnataka

63. Determinants
• Risk Factor
An environmental exposure, aspect of behavior, or
an inherent characteristic associated with a disease.
• Determinant
Risk factor that cannot be modified.

64. Epidemiological Triad
Environment
Agent Host
Disease

65. Host Agent Environment
•Age
•Sex
•Race/Ethnicity
•Genetics
•Intra-oral variations
•Endocrine changes
•Local host factors
•Occupational habits
and neuroses
•Concomitant disease
•Emotional
disturbance
•Bacteria
•Plaque
•Calculus
•Chemical and
physical hazards
•Geographic areas
•Nutrition
•Fluoride
•Degree of urbanization
•Education
•Socio economic status
•Cultural factors
•Professional dental
care
Epidemiological triad

66. • Age
Gingivitis
At population level, found in early childhood, is more
prevalent and severe in adolescence – then level off.
Natural history of periodontal disease – Norway and
Sri Lanka
– No increase in prevalence and severity of gingivitis
between late teen years and 40 years.
- No age related increase in gingivitis
Loe H et al, 1986, 1992
Host Factors

67. - Large epidemiological studies – NIDR,
NHANES – III
prevalence, extent, severity of periodontal
attachment loss with age
- Cross-sectional studies also suggest same
Host Factors

68. • NHANES - III
Host Factors

69. - Andrews & Krogh – periodontal disease
accounts for larger % of tooth loss than does
caries above 40 yrs.
• 15 year study – Sri lankan Tea workers
Based on tooth loss and interproximal CAL
8% - rapid progression
81% - moderate progression
11% - no progression
Loe H et al, 1986, 1992

70. Alveolar bone loss
- Day & Shourie – radiographic survey –
steady progression of alveolar
bone loss with age
• Albandar et al, 1986
Radiographic alveolar bone loss over two years
Increase – 30-56 years , leveled off followed by
slight decrease in 56-68 years age group.

71. Shah N, Doifode V et al, Jagadeesan M et al
• Age – significantly correlated with periodontal
status
• Similar results shown by many Indian studies -
Anil et al, Maity et al
• DCI 2002-2003
Bleeding and calculus – children and young adults
Pockets and LOA – adults, 65-74 years age group

72. Cumulative effect of time. (Burt BA et al
994)
- good indicator of past history

73. • Cross –sectional – extent of CAL among older
more than younger persons
• Lifetime accumulation
• CAL increases rapidly with age among 5-15% -
susceptible
• Susceptibility – young – teenage years.

74. • Sex
- Males > Females
Day – Females – significantly lower bone loss
NIDR (1987) –
Pockets > 4mm AL
Females 9.8 % 25 %
Males 11.5 % 30.9%
Massler et al – Gingivitis also more common in
males
Host Factors

75. • ADA – Males – 0.92-1.25 extractions ;
females – 0.34- 1.06
• NHANES -III
Host Factors

76. • Many Indian studies (Dutta A et al, Nanda RS et
al, Dolwani R et al, Pathak S et al)
• Shah N et al, Doifode V et al – no gender
differences
• DCI 2002-2003
no gender differences

77. • Race- ethnicity
- Russell et al – greater prevalence and
severity of pdl disease
among blacks than white
NIDR Survey
whites blacks
18-24 15 % 17 %
55-64 76 % 90 %
Host Factors

78. • Mandall et al (1998) – 14-15 yr ; Asian
children had higher pdl treatment needs than
whites.
Host Factors

79. • Genetic
- Study of 169 twin pairs concluded that
about half of the variance in periodontitis was
attributable to heredity.
- IL-1 – more severe periodontitis – non
smokers
- an interaction between smoking and
genetics may be a contributory factor in
severity of periodontitis.

80. • Intraoral variations
Bossert & Marks
- Upper molars & lower central incisors –
frequently affected
- Lower bicuspids & upper canines – least
affected.
Loe & associates
- interproximal areas – more severely affected –
upper arch
- Lingual area – lower arch
Host Factors

81. • NHANES –III
- Upper molars & lower central incisors –
frequently affected
- relatively small difference in prevalence of
attachment loss between different types of teeth
• Tewari et al 1979 – lower anterior teeth
• Singh GP et al 1985 – pocket depth

82. • Endocrine changes
- Gingivitis among children as they approach
puberty
(Massler, Russell)
- Females - pregnancy & menstruation
- Hyperparathyroidism, hypopituitarism
• Local Host factors
- Traumatic occlusion
- Food impaction
- Disuse
Host Factors

83. • Tooth morphology and alignment
• Form and location of tooth furcation
• Level and quality of dental restorations
• Dental calculus formation
• Dental caries lesion near gingival tissue
• Oral hygiene pattern
• Alveolar bone morphology
• Gingival form
• Contact between teeth and other local
anatomic factors

84. • Oral Hygiene Practices
- Causal relationship between poor oral hygiene
and gingivitis (Loe & co workers)
- with periodontitis less – gingivitis not always –
periodontitis

85. • Oral hygiene pattern
- Pathak S et al 2000 – brushing twice daily had
lower gingivitis and periodontitis

86. • Eid MA et al 1990
Miswak – affects periodontal attachment at mid
buccal surfaces of anterior teeth and premolars
• Rao SP et al 1993
Wardha 778 2 Urban, 2 Rural and 2 tribal
primary schools
60.8% using Manjan
pdl disease high – ash, Manjan and coal.

87. • Habits
- Neuroses – lip biting
- Occupational habits
- Miscellaneous habits
- misuse of toothbrush
Host Factors

88. Tobacco
Smoking
• 2- 7 fold increase in risk in smokers
(Bergstrom et al 1994, Grossi SC et al 1997,
Tomar SL et al 2000)
• Increased risk in older age cohorts
• 90% of refractory cases – smokers
• Affects healing
• Suppressed hemorrhagic response – gingival
bleeding not good measure.

89. • Doifode V et al 2000
5061 residents, Nagpur
periodontal disease
Smokers 47.8%
Non – smokers 34.2%

90. • Cigar and pipe smoking
• Smokeless tobacco
gingival recession and white mucosal lesions
• Doifode V et al 2000
Periodontal disease
Tobacco chewers 44.4%
Non – tobacco chewers 32.4%
Gutkha 46.1%
Non – gutkha 33.3%
Betel leaf 37.9%
Non betel leaf chewers 33.1%

91. Mean number of sites with gingival bleeding
betel chewers smokers nontobacco
users
22.6+/-21.8 10.8+/11.2 8.7+/-6.8
p<0.0001
• Gingival bleeding - Betel chewers (55.1%) smokers
(27.6%).
• Betel chewing and gingival bleeding +(OR=2.41)
• Smoking and gingival bleeding -(OR=0.75)
• Oral hygiene had the strongest relationship with
gingival bleeding (OR=18.11).
Amarasena N et al 2003

92. • Concomitant disease
- Diabetes & heavy metal poisoning
- Leukemia & anemia
- Debilitating diseases
Periodontal Medicine

94. • Diabetes
- Type I and Type II
- risk factor – exaggerated host response
- metabolic control
Type II – Pima Indians – Gila river community
in Arizona- 2-3 times higher risk of
developing destructive periodontal disease
(Emrich et al 1991)

95. • Chavada MG et al 1993
60 non – diabetic 62 non controlled diabetes
male 30 -66 years
OHI PI
Cases 3.8 4.9
Controls 3.5 4.2

96. Mechanism
• Vascular changes
• Polymorphonuclear leukocyte dysfunction
• Abnormal collagen synthesis
• Cytokine production
• Genetic
• Impaired salivary flow

97. • HIV infection
- necrotizing ulcerative periodontitis
- related to immunosuppression status
- pathogenic bacteria
• Osteoporosis
Krejci CB et al 2002
CAL – greater in osteoporotic women.

98. • Cardiovascular diseases
- chronic inflammation anywhere-affect heart.
- periodontal pathogens – directly injure vascular
endothelium - favor platelet aggregation and
thromboembolic events
- c-reactive protein is a risk factor for
cardiovascular disease- high levels in periodontitis –
clinical and NHANES III

99. Adverse Pregnancy outcomes
Offenbacher S et al 1996 – 7.5 times more likely
Meta analysis
Pre term birth – OR 4.28
Low birth weight - OR 5.28
Either - OR 2.30
Khader YS 2005

100. Pneumonia and COPD
• Oral colonization by respiratory pathogens,
fostered by poor oral hygiene and periodontal
diseases, appears to be associated with
nosocomial pneumonia.
• Additional large-scale RCTs - further evidence
• The results associating periodontal disease and
COPD are preliminary and large-scale
longitudinal and epidemiologic RCTs are
needed.
Scannapieco FA et al 2003

101. • Psychological/ Emotional disturbance /
challenged patients
Related with necrotizing Periodontal diseases
• Mehrotra AK et al (1982)
- 61-physically handicapped - 88.5 %
- 66- mentally retarded individuals -100%
Host Factors

102. • Genco et al 1999
psychological stress, distress and coping behavior
financial strain OR 1.7 attachment loss / alveolar
bone loss
inadequate coping OR 2.2 attachment loss
OR 1.9 alveolar bone
loss

103. • Significant risk indicator
-Psychosocial measures of stress
associated with financial strain and distress

104. • Agent Factors
Plaque
Calculus
Bacterial flora - Aa, P gingivalis, Human
CMV and other herpes viruses
Agent Factors

105. Chemical and physical hazards
- mercury, lead, thallium – dark line
parallel to gingival margin , alveolar
resorption
- Radium and other sources of ionizing
radiation – alveolar damage and
loosening of teeth
- Medication- dilantin sodium

106. • Geographic Areas
Russell
- High – Chile, Lebanon, Jordan Thailand, Burma,
Malaya, Ceylon, India & Trinidad
- Intermediate – US (Blacks), Ecuador, Colombia,
Ethiopia.
- Low – US (White)
Environmental Factors

107. 70% of adults - degree of gingivitis and
periodontitis
Data collected 1980 onwards – WHO global oral
data bank
• Gingivitis and calculus deposits – more
prevalent and severe in low income nations;
• Fewer global difference in prevalence of severe
peiodontitis

108. • Diet & Nutrition
Physical nature
- Coarse & fibrous food – beneficial
( Mehta et al, Borle et al)
- Lower prevalence in non-vegetarians
(Thaha et al,1986)
Environmental Factors

109. - Deficiencies of Vit A, B complex, C & D & Ca & P
- Vit C – gingival bleeding – not known – bone loss or
CAL
- no evidence to support use of nutrients in treatment of
periodontitis.

110. • Fluoride
Russell – severity less in fluoridated areas
Anuradha KP et al 2002
283 36 -45 year old
mean plaque
Shammur 0.5 ppm F 1.45
kendawada 1.1 ppm F 1.21 p< 0.001
Halebathi 3.1 ppm F 1.12
No effect on calculus
Decrease in shallow and deep pockets with increase in
F

111. • Degree of Urbanization
- Slightly higher in rural areas than in urban
areas
- DCI – 2002 – 2003
• Socio-economic status
- More prevalent in lower socioeconomic group
Environmental Factors

112. • Historically - lower SES
• Gingivitis & poor oral hygiene and
subgingival calculus related to lower SES
(Mehta et al, Zaveri et al)
Lack of awareness, inaccessibility to dental
services, inability to afford costly treatments,
inadequate diet

113. • Review , SES affect on periodontitis
Smoking - less effect Klinge B et al., 2005

114. • Education
- Inversely related to increasing levels of
education
Environmental Factors

115. Changing Trends

116. Changing Trends
• Periodontal disease worldwide
• < 10 % - severe periodontitis – complex treatment.
• Majority – mild – moderate periodontitis – scaling,
root planing & OHI
• India – 60 – 90 % - periodontal disease
- 40 – 60 % - Loss of attachment

117. Conclusion
Data from National Oral Health survey being
available – Preventive strategies
HOPE WARNING
SOLVE THE RIDDLE
-cooperative work.

118. References
• Albandar JM, Rams TE. Global epidemiology of
periodontal diseases: an overview. Periodontol
2000. 2002;29:7-10.
• Albandar JM. Global risk factors and risk
indicators for periodontal diseases. Periodontol
2000.2002;29:177-206.

119. • Albandar JM. Epidemiology and risk factors of
periodontal diseases. DCNA 2005; 49: 515-32.
• Petersen PK and Ogawa H. Strengthening the
prevention of periodontal disease: the WHO
approach. J Periodontol 2005; 76: 2187-93.
• Van Dyke TE and Dave S. Risk factors for
periodontitis. J Int Acad Periodontol 2005; 7(1): 3-7.
• Position paper. Epidemiology of periodontal
diseases. J Periodontol 2005; 76: 1406-19.

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community.
New York. Elseiver. 6th
ed. 2005.
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Dentistry, 2nd
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