|Year : 2016 | Volume
| Issue : 3 | Page : 121-127
Periodontal conditions seen in a group of Nigerian older adult patients
Patrick I Ojehanon, Adebola O Ehizele
Department of Periodontics, University of Benin Teaching Hospital, Benin City, Nigeria
|Date of Web Publication||7-Mar-2017|
Adebola O Ehizele
Department of Periodontics, University of Benin Teaching Hospital, Benin City
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: The aim of this study was to determine the pattern of periodontal diagnosis among the older adult periodontal patients seen in a tertiary health facility in Nigeria, based on their demographic factors and level of risk of periodontal disease. Materials and Methods: The clinical records of all the patients aged ≥65 years, treated at the Periodontology Clinic between 2009 and 2012, were used for this retrospective study. The information retrieved from their clinical notes includes their medical history, history of smoking, and alcohol consumption and other demographic data such as age, sex, and socioeconomic class of the participants. Results: More than one periodontal diagnosis was made in 88.8% of the studied elderly, signifying the involvement of multiple sites. All the various diagnoses recorded in this study were more common among the males, i.e., chronic marginal gingivitis (56.6%), chronic periodontitis (54.7%), tooth wear lesions (59.0%), periodontal abscess (56.3%), and gingival enlargement (60%) (P > 0.05). Majority (59.7%) who had chronic periodontitis belong to the lowest socioeconomic class (P > 0.05). Majority (83.3%) who had a high risk of developing periodontal disease were males (P = 0.005). All the older patients with high risk of developing periodontal disease had multiple diagnoses (P > 0.05). Conclusion: It can be concluded that the pattern of periodontal conditions seen in the studied older adults is similar to what has been previously reported and that demographic factors and level of risk of periodontal diseases may influence the pattern of diagnosis.
Clinical Relevance to Interdisciplinary Dentistry
- The older persons present with a variety of periodontal diseases
- Periodontologists and specialists in the area of geriatric dentistry should comanage older person to address all the factors that may militate against optimal plaque control
- Specialists in the area of preventive dentistry should pay special attention to oral health education and promotion among older persons with low economic status and those with lifestyles that are potential risk factors for periodontal diseases.
Keywords: Nigerian, older adults, patients, periodontal conditions
|How to cite this article:|
Ojehanon PI, Ehizele AO. Periodontal conditions seen in a group of Nigerian older adult patients. J Interdiscip Dentistry 2016;6:121-7
| Introduction|| |
Periodontal diseases are chronic in nature and are considered in some quarters as the most common chronic infections in adults. Periodontal diseases are highly prevalent in older persons in this study area as a prevalence of 98% was previously reported among older prisoner. Although periodontal diseases are said to be prevalent in almost every age group, they are more severe with increasing age. This may be because cells in the aging periodontium demonstrate higher production of inflammatory mediators which may affect the severity of the disease. Older persons' face specific challenges which may impair preventive and periodontal care and lead to extensive tooth loss, untreated caries, and untreated periodontal diseases. Such challenges include the fact that older persons have to make out of pocket payments for dental treatments. This is because majority of them do not have health insurance and the few available insurance package may only barely cover medical treatments.Oral health care for older person is also not optimal because dental professionals specially trained to give proper oral health care to older persons are inadequate and the transdisciplinary care model for geriatric oral health care, which requires the involvement of other nondental health-care providers, is still not uniformly implemented. The suboptimal oral care delivery to older person is even more critical in Nigeria, because there is no special dental insurance for older persons, there is no organized system to provide them specialized oral health care, health-care infrastructure is poor, and the few available health-care personnel are concentrated to the urban centers.
Variation in the character and presentation of periodontal diseases in different countries has been reported and attributed to the fact that risk and predisposing factors vary among the peoples of the world. Identified risk factors for periodontal diseases include smoking, systemic diseases, drugs, stress, and obesity., Risk determinants such as socioeconomic status, gender, and genetics , have also been identified. A very important aspect of epidemiology is the actual determination of the pattern of diseases and this step includes measurement of the occurrence of the diseases and comparing their occurrence in two or more groups of people with different risk exposure. An audit of pattern of the presentation of periodontal diseases among the older adult patients is therefore important, especially since the pattern has been reported to vary in different age groups.
A lot has been done in documenting the pattern of presentation of periodontal diseases in children and adolescents.,,,, However, there is paucity in such studies among the older adults, especially in our environment. Studies of age patterns of specific diseases in the older adult population are said to be rare because identification of age patterns of diseases with sufficient precision requires large population-based databases that are costly to collect.
Preventable periodontal problems in the older adults usually present severely and sometimes are difficult to treat completely because of the tissue damage that may have occurred over time. The knowledge of the common types of periodontal diseases among the older adults will help in the formulation of preventive strategies that will make periodontal patients comfortable even in old age without interference with their nutrition. The aim of this study was to determine the pattern of periodontal diagnosis among older adult periodontal patients, based on their demographic factors and level of risk of periodontal disease.
| Materials and Methods|| |
Ethical approval was obtained from the Ethics and Research Committee of the institution before the commencement of the study (protocol number: ADM/E22/A/VOL.VII/863). The study was a retrospective medical record review and did not involve recording of any identifiable information. The investigators were directly involved with the management of the patients.
This retrospective study was carried out in a tertiary health facility located in the South-South region of Nigeria. The clinical records of all the patients aged ≥65 years, treated at the Periodontology Clinic of this tertiary health facility between 2009 and 2012, were used for the retrospective study. The standard protocol for the management of periodontal patients was followed. Therefore, all the clinical records had similar charting methods. The information retrieved from their clinical notes include their medical history, history of smoking, and alcohol consumption and other demographic data such as age, sex, and socioeconomic class of the participants. They were classified into four social classes using a classification  where Class 1 represents the highest socioeconomic class and Class 4 the lowest.
The standard protocol of the Periodontology Clinic is based on a combination of traditional clinical assessments such as presence or absence of clinically detectable inflammation, the extent and pattern of clinical attachment loss, age at onset of disease, rate of progression, presence or absence of miscellaneous signs and symptoms, and the amount of observable plaque and calculus deposits. Therefore, definitive diagnoses were arrived at only after history taking, clinical oral examination, and investigations. The diagnoses were standardized using the 1999 Periodontal Disease Classification System of the American Academy of Periodontology., These definitive diagnoses were extracted from the participants' clinical records for the purpose of this study.
For the purpose of analysis, the level of risk for periodontal diseases was estimated using three risk factors, namely, presence of an underlying systemic disorder, alcohol consumption, and tobacco use. When three of these risk factors are present, the individual is categorized as “high risk.” The presence of two risk factors is categorized as “moderate risk,” 1 risk factor is categorized as “low risk,” and none is categorized as “no risk.”
The collected data were analyzed using the Statistical Package for Social Sciences version 15.0 for Windows (SPSS Inc., Chicago, IL, USA). The results were presented in form of frequencies, percentages, and cross tabulations. Chi-square test was used to determine statistical significance. The level of significance was set at P < 0.05.
| Results|| |
A total of 179 patients aged ≥65 years were seen within the 4 year period. The mean age of this group was 74.3 ± 6.7 years with 62.6% belonging to the 65–74 year age group. There were more males than females in this study (ratio 1.3:1). More than half (55.3%) belong to the lowest socioeconomic class (Class 4). Majority (64.2%) had low risk of developing periodontal diseases while only 3.4% had a high risk. More than one periodontal diagnosis was made in 88.8% of the studied elderly [Table 1].
More persons (58%) in the 65–74 age group and 57.1% in the 75–84 age group were males while majority (55.6%) in the 85–94 age group were females (P = 0.555). There were more males in the socioeconomic Classes 1–3, but majority (58.6%) in Class 4 were females (P = 0.001) [Table 2].
The result showed that all the various diagnoses were more common in males in this study. Chronic marginal gingivitis was diagnosed in 56.6% of the males and 43.4% of the females. Chronic periodontitis was diagnosed in 54.7% of the males and 45.3% of the females, tooth wear lesions was diagnosed in 59% of the males and 41% of the females, periodontal abscess was diagnosed in 56.3% of the males and 43.8% of the females, and gingival enlargement was diagnosed in 60% of the males and 40% of the females (P > 0.05) [Table 3].
|Table 3: Gender difference in the periodontal conditions seen among older periodontal patients|
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Majority (59.7%) who had chronic periodontitis belonged to the lowest socioeconomic class (Class 4) (P = 0.055). However, majority who had chronic marginal gingivitis, periodontal abscess, gingival enlargement, and tooth wear lesions belonged to Class 2 (P > 0.05) [Table 4].
|Table 4: Relationship between diagnosed periodontal conditions and socioeconomic class|
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Majority (83.3%) who had a high risk of developing periodontal disease were males while females made up 59.1% of those who had a low risk of developing periodontal disease (P = 0.005). All the older adults considered to have a high risk of developing periodontal diseases were between 65 and 74 years of age and half of them belong to Class 2 socioeconomic group (P > 0.05) [Table 5].
|Table 5: Relationship between participants' demographic factors and periodontal disease risk factors|
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Sixty percent of older patients with single diagnosis and 64.8% with multiple diagnoses had low risk of developing periodontal disease. All the older patients with high risk of developing periodontal disease, however, had multiple diagnosis (P > 0.05) [Table 6].
|Table 6: Relationship between number of diagnosis and periodontal disease risk factors|
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| Discussion|| |
There were more males than females in this retrospective study. An audit of the pattern of Periodontology Clinic attendance in the South-West region of Nigeria  reported a male:female ratio of 1:1. The difference may be because our study was carried out among the older adults while the South-West study was carried out among all periodontal patients.
Although majority of the older adults in this study belong to the lowest socioeconomic class, there were more women in this class. It has been said that regardless of the race, older women are more likely to be poor. A study  reported that women aged ≥65 years are nearly twice as likely to be poor compared to older men. This may be attributed to the fact that many women work full time taking care of their homes, without getting paid for it, or take up frequently interrupted jobs, which pay less, to be able to meet their family responsibilities.
Periodontal disease has been reported to be higher in men than women. This is supported by this study as all the different types of diagnosis reported in this study, namely, chronic periodontitis; chronic marginal gingivitis, periodontal abscesses, gingival enlargement, and tooth wear lesions were seen more in males. It is worthy of note that other forms of periodontitis such as aggressively progressing periodontitis and necrotizing forms of periodontitis, previously reported in the younger age groups ,,, were not seen among the older adults studied. Gender is a recognized risk determinant of periodontal disease. A systematic review of literature to determine the sex differences in destructive periodontal disease revealed that although men appear to be at a greater risk for destructive periodontal disease than women, men do not appear to be at a higher risk for more rapid periodontal destruction than women. This may be because of hormonal changes, seen at different phases of a woman's development, which may affect cellular differentiation and proliferation. It has been reported that estrogen causes alterations in blood vessels while progesterone stimulates the production of inflammatory mediators.
Chronic periodontitis has been said to be more common in persons belonging to the low socioeconomic class because of they are likely to have poor oral health knowledge and practices resulting in poor utilization of oral health services resulting in oral hygiene which will in turn result in advanced periodontal destruction. The result of this study supports the above because majority of the older adults with chronic periodontitis belonged to the lowest socioeconomic group.
Epidemiologic studies ,, have shown that gingivitis of varying severity is nearly universal. This is supported by this study since 173 out of 179 older adults in this study had chronic marginal gingivitis. The primary etiological factor for gingivitis is bacterial plaque  and the inability of many individuals to maintain optimal plaque control makes gingivitis still very prevalent. The result of this study is, however, higher than the prevalence of gingivitis (75.4%) reported by another study done among adult males in Benin City, Nigeria. Since this study is clinic based, patients with the active form of the disease are expected to present, and this may have accounted for the increase in prevalence of gingivitis reported in this study. It is also interesting to find out that chronic marginal gingivitis was found more among persons in the Class 2 socioeconomic class, that is, made up of skilled and educated persons. This is suggesting that higher socioeconomic class may not necessarily translate to optimal plaque control.
Many of the older persons had clinical signs of varying degrees of periodontal conditions on more than one site, resulting to multiple diagnoses. The implication of this is that majority of the studied older persons would have had more dental appointment for multiple dental procedures and would have spent more money than persons who had only one diagnosis. Multiple diagnoses may also suggest that the periodontal diseases may have been left untreated for a long time and this may have diminished the quality of life of the older persons.
Racial variations have been reported in the severity of periodontal diseases. However, the oral disease burden among older persons can be said to be essentially similar globally. Periodontitis, gingival recession, root and coronal caries, benign mucosal lesions, oral candidiasis, denture stomatitis, and angular cheilitis and xerostomia have been reported to be prevalent among older persons in the United States., Periodontitis and tooth loss were also reported to be prevalent in older Indian populations. The periodontal conditions reported in the study are also plaque-induced periodontal conditions similar to those previously reported globally. The tooth wear lesion seen among older persons in this study could be related to diet. Tooth wear lesion reported among the aging population in China was attributed to the consumption of hard and acidic food.
The roles of the risk factors of periodontal disease considered in this study have been extensively documented. Tobacco use has been said to results in alterations in the oral microflora causing increased levels of certain periodontal pathogens. Host response can also be altered secondary to defective neutrophil function and alteration of antibody production. The effect of underlying systemic disorders, which are multiple in most cases, on the periodontal health can also be enormous. Gingival enlargement can be induced by medications used in the management of some of these underlying systemic conditions. Alcohol consumption has also been suggested to be a contributing factor to tooth wear in Nigeria.
Although all the older patients with high risk of developing periodontal disease had multiple diagnoses, the result of this study is not conclusive on if the level of risk of periodontal disease determines whether an individual will have multiple periodontal diagnoses or not. The major limitation of this study is that it made use of cases that presented during the period of study only. Further studies will be needed to determine the pattern of periodontal involvement among groups selected based on their level of risk of periodontal disease.
| Conclusion|| |
It can be concluded that the pattern of periodontal conditions seen in the studied older adults is similar to what has been previously reported and that demographic factors and level of risk of periodontal diseases may influence the pattern of diagnosis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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