Evaluation of risk of periodontitis in Children- A Retrospective Study

Vaishali S1, Ganesh Jeevanandan*2, Revathi Duraisamy3 1Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India 2Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India 3Department of Prosthodontics, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Science (SIMATS), Saveetha University, Chennai, Tamil Nadu, India


INTRODUCTION
Periodontitis is one of the most common recurring diseases in the oral cavity and is marked by the destruction of connective tissue and alveolar bone support which provokes an in lammatory host response following infection by periodontal microorganisms (Zhang et al., 2009). Severe periodontitis may result in the loss of a tooth from the oral cavity, which occurs in 5 to 20% of the population globally (Albandar, 2002). Periodontal diseases have greater importance in public health globally due to increased prevalence rates and distinguishable social impact on oral health. Recently periodontal diseases have been linked to general population health (Tonetti et al., 2015). Dental plaque is considered to be a risk factor for the initiation and development of periodontal disease (Marsh, 2012). Variety of organisms comprise the dental plaque bio ilm collected from oral surfaces (Kornman, 2008). Accumulation of plaque deposits on the marginal gingiva initiates gingival in lammation that can become chronic on the long run (Caton, 2018). This in lammatory condition is characterised by gingival redness, edema and bleeding on probing, initially called gingivitis which later progresses to periodontitis where alveolar bone loss, loss of attachment and mobility are observed (Newman et al., 2011). Children and adolescents are prone to several forms of periodontitis such as aggressive periodontitis, chronic periodontitis and periodontitis which occurs as a manifestation of systemic diseases (Trombelli et al., 2018). There are two types of risk factors that are associated with periodontitis (Haynes and Stanford, 2003). They are known as modi iable and non-modi iable risk factors. Evidence is reviewed in several studies on the possible roles of modi iable and non-modi iable risk factors associated with periodontitis (Armitage, 1999). Proper knowledge on risk factors is vital for clinical practice (Genco and Sanz, 2020). Modi iable risk factors include various microbial lora and periodontal disease, cardiovascular diseases, diabetes mellitus, stress, obesity and drug-induced diseases and tobacco smoking (Buduneli, 2020). Nonmodi iable risk factors include osteoporosis, host response, haematological disorders. Periodontitis is associated with multiple factors and effective periodontal disease management requires a clear understanding of all associated risk factors which include both modi iable and non-modi iable risk factors. .Periodonitis when occurring in children leads to premature loss of the tooth, affecting the quality of life, resulting in lower self-esteem. Thus screening paediatric patients, early for periodontitis is of utmost importance which results in its early management and improved prognosis. This study therefore acknowledges risk factors of periodontitis in children which therefore educates dental students in early diagnosis and prompt treatment to avoid tooth loss due to periodontitis (Jeevanandan, 2017;Govindaraju et al., 2017b,c).
Previously our team had conducted numerous clinical trials (Somasundaram, 2015;Jeevanandan and Govindaraju, 2018;Govindaraju et al., 2017a) and in vitro studies (Subramanyam, 2018) and systematic reviews (Packiri, 2017;Ramakrishnan and Shukri, 2018) over the past ive years. Now we are focussing on epidemiological surveys. The idea for this survey stemmed from the current interest in the community (Ravikumar et al., 2017;Panchal, 2019;Christabel, 2015). The aim of this study is to access the risk of periodontitis in children by evaluating oral hygiene index and medical condition (Gurunathan and Shanmugavel, 2016;Govindaraju, 2017;Nair et al., 2018).

Study setting
It is a university setting study, conducted in Saveetha Dental College predominantly. The pros of the study are easy retrieval of data, less time consumption. The cons of the study include it is limited to certain populations. Children aged between 5-10 years were selected randomly. Medically compromised children were excluded from the study. Approval was obtained from the Department of Pediatric and Preventive Dentistry, Saveetha Institute of Medical and Technical Sciences. Two examiners were involved.

Sampling
It is a retrospective study. Data were collected from July 1,2019 to March 31,2020. Cross veri ication of data for errors was done through photographs and the presence of additional reviewers. Simple random sampling was done to minimise sampling bias. Eligibility criteria of the sample were de ined. One hundred case sheets were reviewed.

Data Collection
Data was collected after reviewing case records of patients. The data included periodontal status, medical condition and oral hygiene index. Data were entered in a methodical manner in Microsoft Excel and was imported to SPSS. Incomplete or censored data were excluded from the study.

Analytics
Statistical software IBM SPSS 2.0 software was used to analyse the results. Independent variables include time, geographic location. Dependent variables include age, brushing frequency, periodontal status, oral hygiene status, medical condition. Descriptive statistics were used to analyse the age and gender distribution of the study population. Chi-square test was used to ind the association between periodontal disease and medical condition and periodontal disease and oral hygiene index.

RESULTS AND DISCUSSION
In relation to the gender distribution of the study population, it was found that out of 100 children, 54% were males and 46% were females [ Figure 1]. In relation to the periodontal status of the study population, it was seen that out of 100 children, 17% had periodontitis and 83% did not have periodontitis [ Figure 2]. In relation to the association between periodontal status and medical condition it was seen that only 1% of the children with periodontal disease had medical conditions and it was not statistically signi icant ( Pearson Chi-square = 3.549, p = 0.058 (>0.05)) [ Figure 3 and Table 1]. In relation to the association between periodontal status and oral hygiene of the children, it was seen that in the case of periodontitis, oral hygiene was compromised when compared with children who did not have periodontitis. Most of them with periodontitis had fair oral hygiene. The results were statistically signi icant (Pearson Chi-square =53.286, p= 0.000 (<0.05) [ Figure 4 and Table 2].
Periodontitis is characterised by in lammation of soft tissue with evident clinical attachment loss (Nibali, 2018). Presence of periodontitis in children can be due to different food habits, presence of mixed dentition, improper and unsupervised oral hygiene practices and malocclusion (Hiremath et al., 2012). So the present study is to ind an association of the periodontal disease with factors like oral hygiene and medical status of children.

Figure 1: Bar depicts the gender distribution of the study population, where X-axis denotes the gender and Y-axis denotes the total number of patients.
Out of 100 children,54% were males and 46% were females in the study population. Coming to the periodontal disease, 17% of the study population had periodontitis and 83% didn't have periodontitis.
In relation to the association between periodontal disease and medical condition, in the present study, it was found that there was no association between periodontal disease and medical condition. Only 1% of the population of our study with periodontitis had medical conditions. Similar to our study, literature by Wang et al. (Wang, 2014) showed no association between periodontal disease and medical condition. However, literature by Zheng et al. and Deas et al. (Deas et al., 2003) were contradictory to the present study. The probable reason would be age limit, differing sample size and other factors like genetic disorders, socioeconomic status factors might have been included. In relation to the association between periodontal disease and oral hygiene index, there was a statistically significant association between periodontal disease and oral hygiene. In the case of periodontal disease, oral hygiene was compromised. Similar results were shown in studies of Needleman et al. (Needleman et al., 2001), Sharma et al. (Sharma et al., 2019), Felton et al. (Felton and Chapman, 2013). The reason is that improper brushing techniques, unsupervised oral hygiene practices, would have led to compromised oral hygiene,which would have caused plaque   & calculus accumulation, in lammation of the gingival tissues resulting in periodontal diseases ultimately. Improper maintenance and delayed treatment would consecutively result in numerous problems like tooth mobility which would result in tooth loss. There is no literature contradicting this. So assessment of oral hygiene index could be employed in determining periodontal disease.
The limitations of this study include differing sample size, single centered and other factors like genetic disorders, socioeconomic status, host response would have been included.
The future scope of the study is to do an extensive research with large sample size. As periodontal disease in children could lead to premature loss of teeth. This study acknowledges the risk factors which will be helpful for the dentists in early diagnosis, prompt treatment, and better prognosis. Also, it helps in patients motivation, & educating them about the proper oral hygiene maintenance, tooth brushing techniques and devices to maintain proper oral health.

CONCLUSIONS
Within the limits of the study, it is observed that there is a strong association between periodontal disease and oral hygiene. However, it is found that there is no association between periodontal disease and medical condition. In the case of periodontal disease, there is compromised oral hygiene.

Acknowledgement
I would like to thank Saveetha Dental College for allowing me to review the case sheets to complete this study.

Con lict of Interest
The authors declare that they have no con lict of interest for this study.