Determinants of periodontal disease among adult population of Bahawalpur district, Punjab

Periodontal disease is the bacterial infection of the supporting structure of teeth and is a major cause of tooth loss in adults all over the world. After the age of 35 years some form of periodontal disease affects three out of every four persons. According to national health survey of Pakistan 1998, one out of every six persons over the age of 65 years has no natural teeth due to the periodontal disease, indicating it as one of the major public health problems among dental diseases for the adult population of Pakistan. A prevention program based on the knowledge of risk factors in our setting seems an appropriate strategy available for effective community based control for periodontal disease. The objective of this case-control study was to identify the risk factors for periodontal disease among adult population of Bahawalpur district, Punjab Pakistan. We enrolled 250 cases and 250 controls for 1:1 case control ratio matched on age (± 3 years) and gender from various hospitals and dental units of Bahawalpur City. Cases and controls were diagnosed using WHO uniform criteria with CPITN-E-probe (Community Periodontal Index for Treatment Needs). A pre-designed structured questionnaire was used to collect data on hypothetical risk factors. The data were analyzed using conditional logistic regression analysis. Of 250 cases and 250 controls, mean age of cases and controls were 34.56 years with standard deviation of 10.51 years. Over all, the control group belonged to high socio-economic status and was more educated. Our final multivariate model identified five important risk factors for periodontal disease adjusting for other variables in the model. The habit of not cleaning teeth before going to bed had an association for periodontal disease [adj. mOR = 15.35; 95% CI: 3.80, 62.09]. Among the methods of teeth cleaning, teeth cleaning with toothpowder (with or without brush) was associated with periodontal disease [adj. mOR = 5.99; 95% CI: 1.63, 22.07]. Similarly the use of chew-sticks (miswak) or tree barks were also identified as risk factors for periodontal disease [adj. mOR = 4.39; 95% CI: 1.22, 15.79]. History of no dental scaling in the past was also associated with periodontal disease [adj. mOR = 10.29; 95% CI: 2.70, 39.24]. The history of current cigarette smoking was identified as risk factors for periodontal disease while history of past smoking was not making any difference in our study [adj. mOR = 3.53 95% CI: 1.24, 10.08] and for ex-smokers [adj. mOR = 0.54; 95% CI: 0.08, 3.55]. The monthly house hold income from all sources was associated with periodontal disease [adj. mOR = 4.18; 95% CI: 1.54, 11.39] controlling for all the other variables in the model. Daily teeth cleaning before going to bed, annual dental checkup and dental scaling are significant factors for the prevention of periodontal disease. While use of toothpowder, chew-stick or treebark and cigarette smoking are significant risk factors and need careful consideration for prevention of periodontal disease in our setting