Periodontal disease (PD) is an inflammation/infection of the tissues that surround and support teeth  and affects people of all ages. Periodontal diseases (PD) are a collection of infections of the periodontium brought on by harmful microorganisms. Its infections can be triggered and advanced by a number of factors, both local and systemic. Dental plaque and plaque retentive areas, such as dental calculus and faulty restorations, are some examples of the local variables. Neglected diabetes mellitus and chronic cigarette use are examples of the systemic risk factors. The important risk factors include neutropenia, AIDS/HIV infection, and other systemic conditions associated with an immunodeficiency state. Numerous risk factors for periodontal disease have been identified through research. Conditions like stress, the use of coping mechanisms, and the bone loss that results from an absence of estrogen, fall into this category. Gender and genetics are just two of the socioeconomic factors linked to periodontal disease .
Gingivitis is the initial stage of periodontal disease. Failure to treat gingivitis can lead to periodontitis, which in turn destroys supporting the connective tissue and alveolar bone . Cardiovascular, metabolic, cognitive, and autoimmune diseases, as well as respiratory infections and some cancers, have all been linked to periodontitis epidemiologically . In addition, research has linked periodontal disease to other health problems in infants, including premature birth and low birth weight . Patients with poorly managed diabetes mellitus, in particular, have an increased risk of developing periodontitis, which increases both its prevalence and severity over time . The presence of a risk factor increases the likelihood of a disease happening, while its absence or removal decreases this likelihood. Risk factors can be environmental, behavioral, or biological in nature, and its temporal sequence can be established in longitudinal research . Factors associated with each individual tooth including bruxism and high occlusal stress  have been postulated to affect an individual's likelihood of developing the advanced periodontal disease. In addition, about 30% of people on pharmacological therapy including nifedipine, phenytoin, and cyclosporine develop gingival overgrowth . When it comes to the periodontal health, basic oral hygiene has traditionally been seen as a cornerstone . Keeping up with both at-home and professional dental hygiene routines is recommended . Preventing periodontal disease requires a combination of factors, including patient motivation, education, empowerment, oral hygiene teaching, oral hygiene device type, and dexterity . The best and the most widely-recommended strategy for keeping teeth clean and gums healthy is mechanical plaque control using methods like brushing and flossing . Tooth brushing, frequency, duration, and method, occupation, medical history, tooth mobility, furcation involvement, and habits are only few of the patient-related factors that might affect the periodontal health. The purpose of this research is to assess how various patient-related factors influence periodontal health in a cross-section of the Iraqi population.
The purpose of this study is to determine the impact that patient-related factors have on the periodontal health of a representative sample of the Iraqi population.
Materials and Methods
Diagnostic criteria and measurement methods
Gingival inflammation can be quantified using a number of different indices . More objective means of gauging the level of gingival inflammation were utilized. However, these include diagnostic criteria and indices that evaluate the presence, extent, or severity of bleeding from the gums . The index evaluates disease severity based on measures of attachment loss and probing depth. Only the genuine pocket depth (i.e. probing depth apical to cementoenamel junction) is indicated by the measurement of the probing depth .
The periodontal records of the patients from September 2020 to June 2021 were analyzed in this cross-sectional retrospective study conducted at the Department of Periodontics in the Dentistry Department at Al-Rafidian University College in Baghdad, Iraq. Patients' records from the Periodontics and Dentistry divisions at Al-Rafidian University College were used to compile a sample of 564 cases of chronic gingivitis and chronic periodontitis (240 females and 324 males). Participants with chronic periodontitis were given the custom-made questionnaire of the study. Name, age, sex, education, smoking, general health, brushing, flossing, a clinical examination to assess clinical attachment loss, periodontal pocket depth, and tooth mobility are all part of the questionnaire. Based on age and gender, the sample was broken down into the following categories: (within the sample): 10-20 years old, 21–30 years old, 31-40 years old, 41-50 years old, 51-60 years old, and 61-70 years old;
The following criteria were used to the 563 periodontal records that were accessible during the aforementioned time period: Patients having gingivitis or periodontitis according to the 1999 classification of periodontal diseases  and patients aged 10 and up seeking periodontal treatment. Inflamed gingiva with a probing pocket depth (PPD) of less than 4 mm was considered to be suffering from gingivitis. At least two interproximal sites with probing pocket depths (PPDs) of less than 4 mm, or a single site with a PPD of more than 5 mm, as mentioned in reference , constitutes periodontitis. Each patient's details were recorded after they were checked against the inclusion/exclusion criteria. The patient data includes demographics (age, gender, and CC), medical and dental history, smoking status, employment, and diagnosis, and then the clinical measures like plaque index and gingival index were collected using a Williams periodontal probe marked at (1-2-3-5-7-8-9-10 mm).
The recorded clinical parametres include:
Plaque Index (PLI): By utilizing the plaque index .
Gingival index (GI): By using gingival index .
Bleeding on probing (BoP): By using a Williams periodontal probe and passing it to the base of the probable pocket (Gingival Sulcus Bleeding Index) for four surfaces of all teeth , in BOP score "I" is given in case of bleeding emerges within 15 seconds after probing (the presence of bleeding and score "0" for the absence of bleeding.
Probing pocket depth (PPD): Williams periodontal probe was used to measure the distance in millimeters between the gingival margin, the base of the gingival sulcus, or pocket at four surfaces of each tooth.
Method of measurement of clinical attachment level (CAL)
The distance between the cemento-enamel junction (CEJ) and the base of the pocket can be measured to the closest millimeter with a Williams graduated periodontal probe.
Measurement of teeth mobility
The researchers in this study measured tooth mobility with 2 instruments such as dental mirror and probe.
This study was conducted in compliance with the Declaration of Helsinki for human research and was authorized by the Ethics Committee of the Department of Dentistry at Al-Rafidian University College in Baghdad, Iraq.
The data was analysed using SPSS (Version 22.0). Software version of the Statistical Package for the Social Science (developed in Chicago, Illinois, USA).
The following statistical information was used in this investigation:
- Descriptive statistics including frequency and percentages for qualitative variables, means, and standard errors (SE) for quantitative data 1.
- Inferential statistics including the following categories:
- a) One-way analysis of variance: To compare the measured variables between more than two groups and make use of the Hochberg GT2 posthoc test.
- b) Pearson's correlation coefficient test (r): To assess the relation between the measured variables in each group to determine whether or not they are related.
- c) Two independent samples T-test: This test compared two groups statistically and measures the degree of difference.
- d) The Levene test examines whether or not the variance varies consistently across groups.
- e) Pearson Chi square: A relationship between two categorical variables where the estimated cell count is less than five and does not surpass twenty percent.
- f) Fisher exact: A relationship between two categorical variables if the predicted cell count is less than 5 and the percentage of excess cells exceeds 20%.
The following levels of statistical significance were used in the analysis of the statistics.
Non-significant NS P > 0.05
Significant S 0.05 ≥ P > 0.01
Results and Discussion
The association between males and females showed that there was a significant difference in the sample according to age groups and gender (as shown in Table 1 and Figure 1) Chi square p- value=0.001. In addition, the distribution of sample was according to the age group, gender, and diagnosis p- value= 0.000 (as indicated in Table 2). The distribution of sample was according to the age groups, gender, and diagnosis in males (as depicted in Figure 2A). The distribution of sample was according to the age groups, gender, and diagnosis in Females (as shown in Figure 2B), and the distribution of sample was according to the age groups, gender, and diagnosis in the total sample (males and females) (as shown in Figure 2C). Moreover, there were significant differences in the visit to dentist (regular, irregular, and no visit) and diagnosis according to the age group in the total sample p-value=0.000 (as demonstrated in Table 3 and Figure 3). Furthermore, the correlation between clinical parameters was with dental visits of males and females according to the age group (as indicated in Table 4). The distributions of chief complain was according to the age group in total sample (males and females) (as illustrated in Table 5 and Figure 5).
Figure 1: The correlation between males and females of the sample stratified by age groups and gender
Figure 2A: The distribution of sample according to age groups, gender, and diagnosis in Males
Figure 2B: The distribution of sample according to age groups, gender, and diagnosis in Females
Figure 2C: The distribution of sample according to age groups, gender, and diagnosis in the total sample (Males and Females)
Figure 3: The visit to dentist (regular, irregular, and no visit) and diagnosis according to the age group
Figure 5: Distribution of chief complain according to age group in total sample (males and females)
The distribution of the most common complaints was reported by age group (as presented in Table 6).
Table 7 and Figure 7 displayed the distribution of the various types of occupation and diagnosis based on age group in the total sample.
Table 8 and Figure 8 showed the distribution systemic diseases according to age groups in the total sample males and females.
Table 9 and Figure 9 displayed the distribution of method of brushing and diagnosis according to the age group in total sample (males and females).
Table 10 and Figure 10 showed the distribution of habits and diagnosis according to age group in the total sample (males and females). According to the age group of the total sample (males and females).
Figure 7: Distribution occupation and diagnosis according to age group in total sample (males and females)
Figure 8: Distribution systemic diseases according to age groups in total sample males and females
Figure 9: Distribution of method of brushing and diagnosis according to age group in total sample (males and females)
Figure 10: Distribution of habits and diagnosis according to age group in total sample (males and females)
Table 11 and Figure 11 displayed the distribution of frequency of brushing teeth and diagnosis.
Table 12 and Figure 12 displayed the distribution of clinical parameters according to the age groups and gender, there were increasing of periodontal diseases with increase age in males more than females. Table 13 and Figure 13 showed the distribution of clinical parameters and diagnosis according to the age groups and gender, there were more periodontal diseases in old age than in young age patients and in male more than females. Table 14 and Figure 14 showed the distribution of different brushing methods, clinical parameters, and diagnosis (chronic gingivitis and chronic periodontitis). Table 15 and Figure 15 showed the statistical differences between brushing frequency, clinical parameters, and diagnosis (CG and CP). Table 16 and Figure 16 displayed the relationship between mobility of teeth, furcation involvement, and diagnosis. Table 17 revealed the relationship between clinical parameters, diagnosis (CG and CP), mobility of teeth, and furcation involvement. It was found that patients with chronic periodontitis had a greater amount of tooth mobility.
Figure 11: Distribution of frequency of brushing teeth and diagnosis according to age group of the total sample (males and females)
Figure 12: Scatterplot graph of MMP-9 enzyme level with TIMP-1 enzyme level in septic patients who passed away during observation
Figure 13: Distribution of clinical parameters and diagnosis according to age groups and gender
Figure 14: Distribution of brushing method, clinical parameters, and diagnosis (CG and CP)
Figure 15: Statistical differences between brushing frequency, clinical parameters, and diagnosis (CG and CP)
Figure 16: Relationship between mobility of teeth, furcation involvement, and diagnosis
The total of (563) patients were included in the study (234 females and 334 males) in tha age ranges of (10) to (70). Patients' own actions and routines, such as how often they clean their teeth, how hard, and outside influences like smoking can all have an impact on their periodontal health. The purpose of this study was to examine patient-related characteristics and their impact on periodontal health in a representative sample of the Iraqi population. According to the results of this investigation, the prevalence of periodontal disorders increased with age. This disparity may be due to more lifetime tissue degradation than to any inherent increase in periodontal vulnerability with advancing age . Furthermore, this study found that men had a higher prevalence and severity of periodontal damage than women. These findings were comparable with  who discovered the same thing. The gender-specific genetic predispositions  or the other social-behavioral factors may be at play in this observation. In addition, this gender-related finding has repeatedly been documented by numerous studies, with the explanation being that females are generally more concerned with their oral health and overall beauty . Likewise, only 30.22 percent of patients with chronic periodontitis had mobile teeth, which is consistent with the findings of study  that revealed that tooth mobility is commonly present in the most advanced stages of the disease. Moreover, self-care refers to individual self-directed behaviors that a person engages in to maintain and improve their health as well as to prevent and minimize illness. The intial step in assisting patients in better controlling their condition is to improve self-care behaviors, which emphasizes the significance of efficient elements for the patient self-treatment. Self-care also enhances the effectiveness of the illness's therapy and declines the likelihood of complications [27-35].
Periodontal diseases were found less in females than males. Also, there were less periodontal diseases in young patients than in old patients.
M=Male, F=Female, CG=Chronic Gingivitis, CP=ChronicPeriodontitis, N=Number, Sig.=Significant, GI=Gingival index, PI=Plaque index, PPD=Probing pocket, r=correlation cofficient depth, CAL= Clinical attachment loss, P= P-value.
The authors would like to express our deep gratitude to Alrafidain University College, Department of Dentistry for providing the support to conduct this study.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
All authors contributed to data analysis, drafting, and revising of the paper and agreed to be responsible for all the aspects of this work.
Conflict of Interest
The author declared that they have no conflict of interest.
Abdulkareem Hussain Alwan
Basma Fathi Alanabri
Maha Waleed Alghazali
Afnan Abdulkareem Hussain
Farah Abdul_Razzak Mahmood Al_Bazaz
HOW TO CITE THIS ARTICLE
Abdulkareem Hussain Alwan, Basma Fathi Alanabri, Maha Waleed Alghazali, Afnan Abdulkareem Hussain, Farah Abdul_Razzak Mahmood Al_Bazaz. Evaluation of the Effect of Patient Related Factors on Periodontal Condition in a Sample of Iraqi Population: A Retrospective Study. J. Med. Chem. Sci., 2023, 6(5) 1010-1031