Volume 85 • Number 5

Periodontal Diseases in an Omani Adult Population: A Preliminary Study Latfiya S. Al-Harthi,* Mary P. Cullinan,† Jonathan W. Leichter,† and W. Murray Thomson†

Background: Data on the periodontal status of the adult population in the Arab world are scarce. The aim of this pilot study is to assess the prevalence, extent, and severity of periodontal diseases in an adult group from Oman. Methods: This is a cross-sectional study of 319 teachers who were randomly sampled from the list of teachers from the Muscat region schools in Oman. Dental caries, tooth loss, and periodontal attachment loss (AL) were recorded for each of the participants. A questionnaire collected data on participants’ sociodemographic characteristics, dentalcare characteristics, self-rated periodontal status, and selfrated well-being. Results: A total of 99% of participants had at least one site with probing depth (PD) or clinical AL of ‡3 mm. More than one third (36%) of participants had at least one site with AL ‡5 mm, and 12% had at least one site with AL ‡6 mm; for PD, the prevalence estimates were 26% and 8%, respectively, and a gradient by age group was evident across the different thresholds. Regarding the extent of disease, 17.6% of sites had PD ‡3 mm, and 21% of sites had AL ‡3 mm. Conclusions: The prevalence, extent, and severity of periodontitis were higher than estimates reported from industrialized countries, such as Australia, New Zealand, and the United States. This is of concern, especially when considering the relatively young age of the study population. Because of this high prevalence, investigation of periodontitis in a national sample of Omanis is desirable to confirm the findings of this study. J Periodontol 2014;85:e104-e110. KEY WORDS Adult; epidemiology; Middle East; periodontal diseases. * Military Dental Center, Muscat, Sultanate of Oman. † Department of Oral Sciences, Sir John Walsh Research Institute, School of Dentistry, University of Otago, Otago, New Zealand.

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pidemiologic studies of the prevalence, extent, and severity of periodontal diseases make a significant contribution to the development of rational strategies for preventing and controlling periodontal diseases in populations. The global burden of periodontitis has been highlighted recently,1 and one of the goals for the year 2020 is reducing the global prevalence of periodontal diseases.2 However, this goal cannot be reached without previous knowledge of the occurrence of the disease in these countries. Periodontitis may be asymptomatic, or it may present with bleeding on brushing, halitosis, and tooth mobility. Periodontitis may lead to tooth loss.1 Moreover, there is emerging evidence that suggests an association between periodontitis and a number of clinically important diseases and conditions, such as diabetes mellitus3 and cardiovascular diseases.4 Thus, the condition is not only important in its own right as a cause of oral morbidity and tooth loss; its significance may be far greater. Although the prevalence of chronic periodontitis in five major geographic regions has been reviewed,5 very little attention has been given to periodontal diseases in Middle East countries. Most reports from the region are at least 10 years old.3 The only country with recent data using a general population sample is Jordan.6 There is an urgent need for information on periodontitis occurrence among adults in the Arab countries.7 This is an important prerequisite for the doi: 10.1902/jop.2013.130266

e104

Al-Harthi, Cullinan, Leichter, Thomson

J Periodontol • May 2014

Table 1.

Distribution of Public Schools According to Number of Eligible Participants in Each School Province

Participating Public Schools

No. of Eligible Participants

Participating Teachers

Muscat

4

187

55

Matrah

4

136

52

Alamrat

4

217

54

Bosher

4

203

51

Alseeb

4

223

55

Qurayat

4

174

52

24

1,140

319

Total

development of appropriate dental care and prevention strategies in these populations.8 The Sultanate of Oman has a population of 3 million. Muscat is the capital of Oman and has the highest population density. Oral health status data on adults in Oman are non-existent; only surveys of dental caries in children have been conducted.9,10 The aim of this study is to describe the occurrence of periodontal conditions in a sample of Omani adults to test methods for a future national oral health survey. MATERIALS AND METHODS The study was approved by the University of Otago Human Ethics Committee in New Zealand, and the Ministry of Health, Sultanate of Oman. Omani teachers (153 males and 162 females, aged 23 to 50 years; mean – SD age: 30.9 – 5.3 years) were chosen as the population to study because the records of the number of male and female teachers in the schools were readily available and up to date. The material for this cross-sectional study was collected from December 2010 to February 2011. A stratified, proportionate, two-stage cluster sampling design was used, with public schools in the Muscat Governorate as the primary sampling unit. Four public schools from within each province in Oman) were randomly selected. The rationale for this selection was that each province could have its specific geographic location, lifestyles and life habits, level of economic development, and even level of access to health care. The number of eligible teachers in each school was then obtained. The number of schools was obtained from the document on the number of public schools in the Muscat region for the academic year 2010/2011 from the Ministry of Health. The number of teachers was obtained from the registry for the academic year 2010/2011 of each school.

Written consent was obtained from each participant, after which they were asked to complete a structured questionnaire that included the shortform Oral Health Impact Profile,11 together with questions on sociodemographic characteristics, dental care habits, dental visits, smoking habits, and their self-reported general and oral health, including xerostomia and dental hypersensitivity. Participants were assigned to income group tertiles based on selfreported household income. Participants were asked how frequently they usually brushed their teeth (more than twice daily, once daily, less than once daily), what they use to brush their teeth, and what interdental cleaning aids they use. Information on the frequency of and reason for visiting a dental professional was obtained by asking the participant about his or her most recent dental visit and the reason for this visit (check-up, problems with teeth or gums, and pain with teeth or gums). Self-reported periodontal disease was determined by asking the following questions: 1) ‘‘Do you have gum disease?’’;12 2) ‘‘Has any dentist/hygienist told you that you have deep pockets?’’;13 and 3) ‘‘Have you had periodontal disease with bone loss?’’14 The number of participating teachers by province is provided in Table 1. Dental examinations were conducted by four examiners who had been calibrated. These examinations were undertaken in each selected school using portable dental chairs. The primary investigator (LSA-H) was trained and calibrated with a ‘‘gold-standard’’ examiner (JWL) at the University of Otago School of Dentistry, Otago, New Zealand. During the training sessions, the examiners became acquainted with the examination criteria and practiced examining patients following the instructions and criteria. The examiner (LSA-H) also underwent training to train examiners (Sabri AlBusaidi, Asma Al-Tuhai, and Asmahan Al-Maskri, Ministry of Health, Muscat, Sultanate of Oman) and the rest of the participating team in Oman. Intraand interexaminer calibration was conducted at the University of Otago School of Dentistry between examiners (JWL and LSA-H). LSA-H then trained the other examiners in the Ministry of Health in Oman. A school not chosen by the random selection process was invited for calibration of the examiners. Intra- and interexaminer reliability was checked using replicate datasets, k scores, and intraclass correlation coefficients. Repeat examinations for the purpose of reliability assessment were checked between the primary investigator and the other examiners. Teachers with 2interproximal sites with AL >4 mm (not on same tooth) or >2 interproximal sites with PD >5 mm (not on same tooth)

126 (40.0)

Severe periodontitis

>2 interproximal sites with AL >6 mm (not on same tooth) and >1 interproximal site with PD >5 mm

7 (2.2)

six sites (mesio-buccal, mid-buccal, disto-buccal, disto-lingual, mid-lingual, and mesio-lingual) on each fully erupted tooth, excluding third molars. Gingival recession (GR) was defined as the distance (in millimeters) from the cemento-enamel junction to the free gingival margin (FGM). Probing depth (PD) was defined as the distance from the FGM to the bottom of the periodontal pocket. Bleeding on probing (BOP) was recorded as ‘‘yes’’ or ‘‘no,’’ indicating whether, after probing to the base of the pocket, bleeding was observed immediately after probing at any buccal or lingual site. Bleeding that did not appear within the time of measuring the three buccal/lingual sites was not recorded. The prevalence of periodontal breakdown was calculated as the percentage of persons with a clinical parameter (PD and/or attachment loss [AL] of ‡x mm) at one or more sites. The extent of periodontal breakdown was calculated at the person level as the mean percentage of sites with ‡x mm GR, PD, and AL. Gingival inflammation was quantified by measuring BOP. A statistical software package§ was used for data analysis. The combined AL for each site was computed by summing the measurements for GR and PD. Differences in percentages were tested for statistical significance using x2 tests. Differences in means were tested for statistical significance using Mann-Whitney U tests or KruskalWallis tests, as appropriate. The a value was 0.05. For comparison with other published studies, the prevalence of periodontitis was also reported using the Centers for Disease Control and Prevention– American Academy of Periodontology (CDC–AAP) case definitions15 proposed for population-based surveillance of periodontitis, with the following case definitions: 1) no periodontitis; 2) mild periodontitis; e106

171 (54.3) 11 (3.5)

3) moderate periodontitis; and 4) severe periodontitis (Table 2). RESULTS Of the 334 teachers teaching in 24 schools in the Muscat region who were invited to participate in the study, 319 (95.5%) agreed and signed a consent form. During the dental examination, four teachers were found to have

Periodontal diseases in an Omani adult population: a preliminary study.

Data on the periodontal status of the adult population in the Arab world are scarce. The aim of this pilot study is to assess the prevalence, extent, ...
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