Indian Journal of Community Medicine Vol. 30, No.

2, April-June, 2005

A Study of Epidemiological Factors Influencing Periodontal Diseases

in selected Areas of District Ludhiana, Punjab
M. Sood

Introduction Systematic random sampling chose 500 urban and 500 rural
subjects Periodontal status of each of study subjects was
The periodontium consists of investing and supporting tissues
assessed as per recommendations of the World Health
of teeth i.e. gingivae (gums), periodontal ligaments, cementum Organization10,11. Instruments used were sets of plane mouth
and alveolar bone. It is widely affected by dental plaque-a mirror and periodontal probe with graduated shank, which were
diverse microbial community found on tooth surface, disinfected in 2% glutaraldehyde after each use. Data were
embedded in a matrix of polymers of bacterial and salivary analyzed on computer using spss software. Chi square test
origin(1). Later other supporting structures become involved of significance was applied.
so that small pus filled pockets form around teeth. There is
loss of attachment and bone loss leading to tooth motility. Results
Epidemiological studies conducted in various countries report In the present study 94 subjects admitted to being current
that 5-20% of any population will have severe forms of smokers while 30 were former smokers. Prevalence of bleeding
periodontitis and moderate disease affects a majority of gums was 85.1% and 86.7% in current and former smokers
adults(3). Studies conducted in India show that every second are compared to 66.5% in never smokers. This difference is
person above the age of 35 years has gum pockets and 35% statistically significant. (Table I)
of total teeth extracted after the age of 35 years are due to
Out of 34 subjects with previously diagnosed coronary artery
periodontal disease(4). The disease process is enhanced under
disease, only 17.6% showed healthy periodontium as
the effect of smoking/tobacco5,6,7 and predisposes to coronary
compared to overall 29.3% prevalence in general population,
heart disease(8) due to an increased risk of thromboembolic
82.3% subjects with coronary artery disease (CAD) showed
phenomena.
bleeding gums, 100.0% showed calculus, 82.3% shallow and
Material & Methods deep periodontal pockets and 79.4% showed loss of tooth
The present cross-sectional study on epidemiological attachment. These findings depict a significant association
correlates of periodontal disease was carried out in field of coronary artery disease with periodontal disease when
practice areas of Dept. of Social and Preventive Medicine, compared with prevalence of above-mentioned conditions in
Dayanand Medical College, Ludhiana Statistical estimates of general population (97.0%, 29.1%, 12.5% and 13.3%
sample size were made according to established formulae (9). respectively. (Table II)
Table I - Comparison of Periodontal Status of Subjects as per Smoking Habits
Type of Number Community Periodontal Index (CPI)
smoker Examined Healthy Bleeding Calculus Pocket Pocket Loss of
(4-5mm) (>=6mm) Attachment
N % N % N % N % N % N %
Never 876 275 31.4 583 65.5 846 96.6 198 22.6 65 7.4 70 7.9
Current 94 15 15.96 80 85.1 94 100.0 74 78.7 51 54.3 54 57.4
Former 30 3 10.0 26 86.7 30 100.0 19 63.3 9 30.0 9 30.0
Total 1000 293* 29.3 689* 68.9 970* 97.0 291* 29.1 125* 12.5* 133 13.3
*p < 0.01
Table II -Periodontal Status of Subjects with Respect to Smokeless Tobacco Use
Form of Number Community Periodontal Index (CPI)
Tobacco Examined Healthy Bleeding Calculus Pocket Pocket Loss of
(4-5mm) (>=6mm) Attachment
N % N % N % N % N % N %
Khaini 120 0 0.0 118 98.3 120 100.0 108 90.0 65 54.2 50 41.7
Quid 16 2 12.5 13 81.2 16 100.0 13 81.2 10 62.5 09 56.2
Zarda 155 19 12.3 118 76.1 155 100.0 121 78.1 74 47.7 73 47.1
None 701 210 29.9 470 67.0 673 96.0 168 24.0 56 8.0 56 8.0
Misri 08 2* 25.0 6 75.0* 8 100.0* 6 75.0 4 50.0 4 50.0
* p<0.01

Deptt. of Community Medicine, DMC, Ludhiana

70 Epidemiological Factors Influencing Periodontal Diseases

 Indian Journal of Community Medicine Vol. 30, No. 2, April-June, 2005

Table III -Comparison of Periodontal Status of Subjects with Respect to Presence of Coronary Artery Disease
Subjects Number Community Periodontal Index (CPI)
Examined Healthy Bleeding Calculus Pocket Pocket Loss of
(4-5mm) (>=6mm) Attachment
N % N % N % N % N % N %
With Coronary 34 .06 17.6 28 82.3 34 100.0 28 82.3 28 82.3 27 79.2
artery disease
Total subjects 1000 293 29.3* 689 68.9* 97 97.0* 291 29.1* 125 12.5* 133 13.3

P value *P <0.01

Discussion References

The fact that tobacco smokers have a higher prevalence of
periodontal disease has been documented in various studies.
In a study on peripheral blood monocytes from healthy non-
smoking donors it was found that nicotine leads to increase
in secretion of prostaglandin E2 via up-regulation of
lipopolysaccharide mediated pathways. More over smokers
also tend to have a poorer oral hygiene status than non-
smokers2. Smoking also reduces antibodies in saliva and leads
to xerostomia which can cause many oral health problems
(www.Periodontitis.net). The influence of smoking on adult
Periodontitis and serum IgG2 levels has been established12.
A strong association between smoking and attachment loss
was found in a study in subjects with minimal or no periodontal
disease13. The vasoconstrictive effect of nicotine causes a
reduction in gingival blood flow, which translates into a
weakening of defenses of gingiva14. Smoking also depresses
level of circulating antibodies, chemotactic and phagocytic
activities of oral polymorphonucleocytes.
A higher prevalence of periodontal disease in smokeless
tobacco users has been reported elsewhere also15. Poor oral
hygiene status of these subjects has been shown to play a
major role in this in addition to the effect tobacco per se has
on periodontal tissues that is irritation of tissues and lowering
of their resistance.
The association between cardiovascular disease and
periodontal disease has been extensively studied. It is a well
known fact that periodontal infection leads to a systemic
exposure to bacteria during dental manipulations and that the
infection periodontium may be a source of potentially
deleterious mediators 3,14 . Two important limitations
encountered during the course of study were (a) subjectivity
of response of subjects with regard to personal habits could
not be ruled out. (b) Relatively small sample size in age group
above 60 had to be accepted in view of exclusion criteria of
edentulous persons. However, a need for increasing the
awareness of people regarding oral health is clearly evident
from the findings of this study.
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71 Epidemiological Factors Influencing Periodontal Diseases