Prevalence of periodontal diseases among the patient visiting at Periodontology OPD Update Dental College Hospital , Dhaka

a. Assistant Professor, Department of Oral Pathology & Periodontology, Update Dental College & Hospital, Dhaka b. Lecturer, Department of Oral Pathology & Periodontology, Update Dental College & Hospital, Dhaka c. Medical Officer, Department of Oral Pathology & Periodontology, Update Dental College & Hospital, Dhaka d. Intern Doctor, Department of Oral Pathology & Periodontology, Update Dental College & Hospital, Dhaka e. Intern Doctor, Department of Oral Pathology & Periodontology, Update Dental College & Hospital, Dhaka f. Intern Doctor, Department of Oral Pathology & Periodontology, Update Dental College & Hospital, Dhaka


INTRODUCTION
Periodontal disease is a common chronic inflammatory disease.In older adults it may increase patient's risk of developing systemic diseases such as diabetes mellitus, lung disease, heart disease and stroke. 1 Priodontal infections have also been implicated as one of several factors in the development of coronary heart disease. 2 Oral infections may have an association with the occurrence and severity of a wide variety of systemic conditions and diseases such as heart diseases, preterm low birth weight babies, respiratory diseases and diabetes mellitus. 3WHO report (2005)  described that the global problem persisted with the worldwide oral diseases such as dental caries, periodontal disease, tooth loss, oral mucosal lesions and oropharyngeal cancers. 4.Stillbirth, neonatal and perinatal deaths were reported to be increased with the severity of periodontal disease. 7Bone loss in periodontal disease may also occur in bursts of osteoclastic activity, triggered by cells or factors generated during an acute phase. 8ere was a positive correlation observed, between the female gender and the occurrence of periodontal disease. 9.Incidence of incipient periodontal destruction has pragmatically increased with age, the highest rate occurs between 50 and 60 years of age. 13Moderate periodontal disease has been reported being prevalent among very old dentate adults while advanced periodontal disease was much less prevalent. 14It was found that the risk indicators for a higher prevalence of periodontal disease included increasing age, poor education, and lack of professional dental care. 15According to the WHO report (2003), the socio-environmental determinants to oral disease were highly related to the lifestyle factors. 16Frequency of chronic periodontitis in a cross section was studied by chaudhry et al in Pak Army Personnel.They detected that 32.04 % of subjects in the population had a poor level of oral hygiene and consequently suffered from chronic periodontitis. 17Subgingival calculus was reported to be closely associated with gingivitis and Periodontitis. 18evalence of periodontitis associated with a healthy lifestyle was significantly lower when compared to an unhealthy lifestyle. 19.The aim of the study was to report the prevalence of periodontal diseases with regards to age & sex in a population of patients reporting to Update Dental College & Hospital, Dhaka.

METHODOLOGY
A cross sectional study was conducted to evaluate the occurrence of periodontal diseases in male and the female population, in the department of periodontology of Update dental College and Hospital.A routine oral examination was performed for the diagnosis, for which a patient's examination form was used to record the data.Only the dentate patients who attended the out patients department of Periodontology of Update Dental College & Hospital during year 2014-2015, were included in the study.Three distinct levels were considered for screening of the patients i.e. gender, age and type of periodontal diseases ( Gingivitis and periodontitis).Diagnosis was derived from the information obtained from the patient's medical and dental history, regarding the predisposing disease combined with findings from a thorough intraoral examination.Screening of the patients was done by their clinical examination, performed by the dental officer assisted by some Intern doctors with a dental assistant, with the help of sterile instruments i.e. mouth mirrors, explorers, CPITN probe, disposable gloves, and masks, while the patients seated in the dental chair.

Evaluation of the disease was done by the visual method of examination. In this study we follow Community Periodontal Index for Treatment Needs (CPITN):
1=The dentition divided into six sextants (One anterior and two posterior) 2=Probing assessment are performed either around all teeth in a sextant or around certain index teeth.3=The periodontal conditions are scored as follows: For each sextant.4=The treatment needs (TN) are scores based on the most severe code in the dentition as TN=0 in case of gingival health, TN 1 indicating need for improved oral hygiene if code 1 has been recorded, TN 2 indicating need for scaling , removal of overhangs, and improved oral hygiene (Codes 2+3) and TN 3 indicating complex treatment complex treatment (code 4).
Where there was an apparent gum recession especially due to the deposition of calculus, was recorded as Chronic Periodontitis.CPITN probe was used where needed, according to the standardized method.In the subjects where the code of CPITN appeared 3 or more, it was also regarded as Chronic Periodontitis.This is said to be an accurate method of recording, and time efficient in the outpatient department. 20It is important to note, the diagnosis criteria of Armitage (2000), that the probing depth measurements was not used as the primary criterion for establishing the severity of periodontitis.According to him, the gingival margin is not a fixed reference, it can be considerably coronal to the cementoenamel junction in pathological conditions, and can be apical to the cementoenamel junction in the case of gingival recession.Therefore it was not considered as a good reference point to assess the longitudinal changes in clinical attachment. 21is diagnosis criteria was considered and implemented in this study.A pre designed patient's examination form was used to keep the proof of the entire data.The state of Chronic or adult Periodontitis was recorded, as consisting of chronic inflammation of the periodontal tissues with the accumulation of profuse amounts of dental plaque. 22

DISCUSSION
The prevalence is the number of cases in a designated population at a given point.Any Prevalence information must be interpreted in light of the population studied.It was the first effort of the periodontology department in Update Dental College & Hospital, Dhaka.Among 2130 patients were examined in the out patients department during the year 2014-2015.
In the present study, the prevalence of gingivitis was found 85% .Gingivitis were more prevalent in the teenage group as compared to periodontitis that were more prevalent in older age groups.Out of total patient suffering from gingivitis 56% of male and 43.6% of females.Males suffered more from gingivitis then as compared to females.This is similar to the study on American population showed males were affected more as compared to females by Li Y, Lee S, Hujoel P in their study. 23This is opposite to a study conducted by Zhang J. on Chinese adult population which showed no difference between gender based distribution of gingivitis 24 .The factors responsible for this finding may be that males are less health conscious and have poorer oral hygiene than female due to heavy deposition of plaque and calculus. 25he possible another reason for the negligence to maintain their oral hygiene could be, due to the workload on the males, being the single earning member for the whole family.Hence the results appeared in accordance with the previous reports.:2).In the developing countries, like Bangladesh, the awareness of the people to maintain their oral hygiene is lacking, as a result the disease which was developed at an early age progressed to its severity with the passage of time when the patient reached at an older age However there are some other reports on the prevalence of periodontitis that allowed the comparison with our study e.g. the incidence of incipient periodontal destruction increased with age, the highest rate occurred between 50 and 60 years. 13An overall prevalence of periodontitis 70.9 % and 87.4 % was reported to be higher in both the age groups i.e. adults (35-44 years) and seniors (65-74 years) respectively. 11milarly the prevalence of periodontitis was also reported, increasing significantly with age and remained constant after the age of 50-59. 27 was observed that most of the patients from the rural areas were undernourished, having high levels of undisturbed dental plaque, which was the main cause of destruction of their oral and periodontal tissues.There are several reports revealing the association of periodontal diseases with various systemic diseases, 1,2,3,4..It is therefore important to control and treat the disease in its initial stages to improve the public health.

CONCLUSION
The study detected that a perceptible percentage of the subjects had a poor level of oral hygiene and consequently suffered from Periodontal diseases.The main causative factor was, the unhealthy conditions in which they live and a deprived literacy rate in such population, resulting into a deplorable understanding regarding the awareness to maintain their oral hygiene.Oral diseases are major public health problems in all regions of the world, eventually effecting the general health and the quality of the lives among the individuals and communities.The worthwhile goal should be the prevention and treatment of the disease, which could only be achieved by population's awareness programs.

Figure: 02 :
Figure: 02: Distribution of periodontal disease with age

Table : 3 Account of total number of patients and periodontal diseases with gender Table: 4 Overall scenario with age , gender and periodontal disease:
9,10,11,12