Case-control Study Of The Risk Factors For Moderate To Severe Chronic Periodontitis

Chronic periodontitis is an infectious disease which can lead to the inflammation of dental organizations for supporting,progressive loss of attachment and bone resorption.It's characterized by the formation of gum pockets or gingival recession. Chronic periodontitis is the most common type of periodontitis,and it may happen at any age,but most of them are adult persons.The prevalence rate and severity of this disease increases with age,involving a different number of teeth,the degree of progress can be different.The incidence and the continued existence of chronic periodontitis dependent on the plaque,but the host defense mechanism of pathogenesis also plays an essential role.The progress of the disease can only be learned through repetition check.Periodontitis patients with chronic periodontitis account for about 95%,from the long-standing chronic gingivitis to the deep periodontal tissue caused by the expansion.Periodontitis in the prevalence rate increased significantly after the age of 35 and with age,severity increased.According to the 3rd national oral health epidemiological survey of 2005^[1],12-year-old boy bleeding gums rate of Chinese is 57.7%,calculus rate is 59.0%.The rate of calculus between 35 to 44-year-old adult is as high as 97%,bleeding gums rate is 75%;the rate of pocket depth = 4 mm or attachment loss being 4～5 mm was as high as 38%.The survey also revealed that the age group of periodontal health was only 14.2 percent. 65 to 74-year-old elderly group did not bleeding gums,there is no pocket and no severe periodontal attachment loss rate of only 13.6 percent.At present,China has become periodontitis tooth loss of the top reasons^[2],prevention and treatment of periodontal disease is extremely critical^[3].Periodontitis compared with clear risk factors for oral hygiene,there are situations,sex,age,race,certain systemic diseases, some of the micro-organisms and so on.In recent years,a growing number of studies show that the susceptible host and the host can increase susceptibility to certain factors that affect the incidence of periodontal disease,the type of process and response to treatment an important factor.Etiology research on periodontal disease research,help us to find moderate to severe chronic periodontitis impact of risk factors.For a variety of risk factors,contribute to severe chronic periodontitis in the diagnosis and treatment and,more importantly,early prevention,to reduce periodontitis caused by tooth loss rate and improve the quality of life and health of patients.In order to explore the moderate to severe chronic periodontitis risk factors for clinical prevention and treatment to provide a basis in Zhengzhou City Center Hospital carried out this study dentistry.Materials and methods1.We choose 203 cases of adult patients with severe periodontitis cases as case group and the patients without periodontitis in the same period as a control from January 2006 to June 2007 in Zhengzhou City Hospital's stomatology.We did survey questionnaires,oral examination and imageological examination for the subjects.We matched them with 1:1 matching design,in accordance with the age, sex,education,place of residence.2.Questionnaires surveys include the study of demographic data,behavioral risk factors,mental factors related to periodontal disease,the history of oral health habits and medical treatment,as well as behavior;the oral examination will include debris index-simplified(DI-S),calculus index-simplified(CI-S),oral hygiene index-simplified(OHI-S),probing depth(PD),decayed and filled tooth(DFT),whether or not with repair bad,food impaction,wrong deformed jaw, jaw trauma.Imageological examination included oral pantomography.3.The SAS 9.13 statistical package was used to analyse data.We used the chi-square test to calculate OR and 95%CI before to be adjusted.Logistic regression analysis was used to calculate the adjusted OR and 95%Cl,then to screen of risk factors of moderate to severe chronic periodontitis.Statistical significance was defined at the 5%level.Results1.The general situation of the object of study203 pairs of subjects were recruited in this study including 108 pairs of male subjucts(53.20%) and 95 pairs of female subjucts(46.80%),51 pairs of subjects with college or above(25.12%) and 152 pairs with high school or below(74.88%),189 pairs of city residents(92.86%) and 14 pairs of rural residents(7.14%).Cases had balanced age(t=0.88,P =0.38).The average age were 53.24±4.32 and 53.02±2.36.The case group and control group included peasant 4.93%and 11.33%,worker 47.78%and 43.84%,cadres 18.23%and 21.18%,professionals＆technical 25.62% and 23.65%,drinker 51.23%and 45.32%,tea-drinker 62.56%and 58.62%,smoker 34.96%and 24.14%,respectively.2.The periodontal situation of object of study2.1 The check status of periodontal organization between the case and control groupsIn case group there were 165 moderate cases of periodontitis patients and they accounted for 81.4 percent of those surveyed.Patients with severe periodontitis were 38 cases and accounted for 18.6 percent.There were 4714 examined teeth and 974 missing teeth in case group,5375 examined teeth and 309 missing teeth in control group.The average PD and average clinical attachment loss(CAL) were 2.53±0.64mm and 2.66±0.78 mm respectively in case group,and 2.11±0.32 mm and 0.37±0.43 mm respectively in control group.The average PD and CAL of the two groups had statistical difference,t =7.87,P＜0.01;t =57.24,P＜0.01. 2.2 The bone situation of case and control groupsThe high degree of alveolar bone and PMI of case group were 6.17±1.66mm and 0.28±0.08;the high degree of alveolar bone and PMI of control group were 10.99±1.26mm and 0.47±0.16.By statistical tests,two groups of alveolar bone and the PMI have a high degree of statistical difference,t =26.79,P＜0.01:t =9.44, P＜0.01.3.Single-factor analysis15 factors were related to the chronic moderate to severe periodontitis.Simplify the index calculus,non-performing repair,smoking,simplified oral hygiene index for personal,food impaction,systemic diseases,stress,jaw trauma,the last two years of negative life events,debris index simplified to the risk factors,the value of the OR and 95%CI were 4.33(1.42,13.15),3.99(1.71,9.32),3.91(1.93,7.93),2.90(1.96, 4.29),2.67(1.33,5.40),2.31(1.21,4.42),2.28(1.09,4.77),1.93(1.12,3.69),1,48 (1.22,1.79) and 1.35(1.22,1.50).The oral health education,toothbrush for a short time,brush their teeth longer,the correct brushing methods,brush their teeth more often are the protection of factors,the OR and 95%CI were 0.80(0.67,0.96), 0.68(0.47,0.99),0.36(0.18,0.72),0.17(0.07,0.39) and 0.15(0.07,0.30).4.Multivariate logistic regression analysisSingle factor analysis of the significant factors that conditions for multi-factor logistic regression analysis,the results of the 8 factors into the model:simplify the index calculus,smoking,simplified oral hygiene index for personal,stress,systemic diseases and negative life events for moderate to severe chronic periodontitis disease risk factors,the value of the OR and 95%CI were 3.37(1.05,10.78),3.30(1.51,7.23), 2.50(1.59,3.94),2.19(1.13,4.71),2.11(1.04,4.46) and 1.43(1.21,1.68).Brush the correct approach,the number of brush for the protection of factors,the value of the OR and 95%CI were 0.26(0.12,0.57) and 0.21(0.11,0.40).Conclusions1.Patients with moderate and severe chronic periodontitis have alveolar bone absorption and mandibular cortical bone loss,bone mineral density lower at the same time.2.CI-S,OHI-S,smoking,systemic disease,work pressure and negative life events are risk factors of moderate and severe periodontitis chronic periodontitis,the correct method of brushing teeth and the more brushing the teeth are protective factors.As a result,the prevention and control of chronic moderate and severe periodontitis,oral health education should be enhanced publicity and guidance to develop good oral hygiene habits,the promotion of the right brush for ways to improve the oral health status,patients with periodontitis to improve oral health and the ability to maintain periodontal health;actively promote smoking cessation;the treatment of periodontitis associated with systemic diseases,maintain a healthy physical and mental state.