|Year : 2022 | Volume
| Issue : 3 | Page : 311-316
Prevalence of gingival recession and associated etiological factors among the school children
Sonia Sudeepthi Seemakurthy1, Sailavanya Nuvvula2, Sreekanth Kumar Mallineni3, Sivakumar Nuvvula1
1 Department of Paediatric and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
2 Department of Periodontology, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India
3 Department of Paediatric and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, India; Division for Globalization Initiative, Liaison Center for Innovative Dentistry Graduate School of Dentistry, Tohoku University, Sendai, Japan
|Date of Submission||17-May-2021|
|Date of Decision||14-Sep-2022|
|Date of Acceptance||17-Sep-2022|
|Date of Web Publication||18-Oct-2022|
Department of Paediatric and Preventive Dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objective: The objective of this study is to assess the prevalence of gingival recession (GR) and associated etiological factors among school children. Methodology: The study sample consisted of 2095 children from the Nellore region divided into three groups of age ranges from primary dentition (<7 years), mixed dentition (7–12 years), and permanent dentition (>12 years) respectively, attending the department of pediatric and preventive dentistry and the school dental health programs organized by the department. The clinical examination involved measuring GR using William's periodontal probe and evaluating associated etiological factors. Data were statistically analyzed using the Chi-square test. Results: The GR among the study population was 7.9% (n = 165). Among them, males were 46% and females were 54% (P > 0.05). The GR was more in children in the 7–12 years age group (75%), followed by <7 years (21%) and >12 years (4%) age groups. The associated factors include malocclusion (69%), deleterious habits (5%), and anomalies (26%). Anomalies showed an association with GR (P < 0.05) compared to malocclusion and deleteriousness habits (P > 0.05). Conclusion: The prevalence of GR is 7.9%, and GR is more prevalent in males and the 7–12 years age group. GR is associated with transient malocclusion, deleterious habits, and anomalies.
Keywords: Etiological factors, gingival recession, prevalence
|How to cite this article:|
Seemakurthy SS, Nuvvula S, Mallineni SK, Nuvvula S. Prevalence of gingival recession and associated etiological factors among the school children. J Indian Soc Pedod Prev Dent 2022;40:311-6
|How to cite this URL:|
Seemakurthy SS, Nuvvula S, Mallineni SK, Nuvvula S. Prevalence of gingival recession and associated etiological factors among the school children. J Indian Soc Pedod Prev Dent [serial online] 2022 [cited 2022 Nov 29];40:311-6. Available from: http://www.jisppd.com/text.asp?2022/40/3/311/358826
| Introduction|| |
Gingival recession (GR) is “the location of the gingival margin apical to the cementoenamel junction.” Biomorphologic integrity and maintaining an enduring attachment to the teeth and the underlying soft tissue are always essential for an adequate mucogingival complex. Mucogingival alterations present as either close disruption resulting in pocket formation or open disruption resulting in gingival clefts and GR. The prevalence of GR increases with age. GR is a multifactorial disease that includes deleterious oral habits, high frenal attachment, excessive or inadequate or faulty tooth brushing, occlusal trauma, destructive periodontal disease, alveolar bone dehiscence, smoking, and tooth malposition.
Localized GR sporadically presents a problem in children, and there is some confusion regarding the etiology and pathogenesis. Sognnaes reported a significant relationship between GR and various factors such as faulty tooth brushing technique (gingival abrasion), wrong positioning of the tooth, friction from soft tissue (gingival ablation), gingival inflammation, and high frenum attachment. Baker and Seymour found that plaque-induced inflammation is responsible for GR. The available literature shows minimal surveys on GR's prevalence among children, and the majority of the studies on GR were focused on adults. None of the published articles in the literature discussed gender and age influence GR and associated factors. There is a need to establish the prevalence of GR and its associated factors among school children. The rationale of the present article was to evaluate the prevalence of GR and related associated factors among school children.
| Methodology|| |
The ethical clearance was attained from the Institutional Ethical Committee of Narayana Dental College and Hospital, Nellore (NDC/IECC/PEDO/12-1/01). The study was conducted between December 2017 to December 2018. Children attending the Department of Paediatric and preventive dentistry, Narayana Dental College and Hospital, Nellore, Andhra Pradesh, and those attending school dental health programs were selected. Healthy children aged 6–15 years whose parents were willing to provide informed consent were included in the study. Children with systemic diseases, special care needs, undergoing orthodontic treatment, and whose parents were unwilling to provide informed consent were excluded from the study.
A nonprobability convenient sampling method was used, and 2095 children were recruited from the outpatient department and those who participated in the school dental health program. The oral examinations were carried out using type III examination (inspection using mouth mirror and explorer and adequate illumination) and all the clinical examinations by a single trained and calibrated examiner. The baseline oral hygiene status assessment using Greene–Vermillion index, GR, and molar relation using Mahajan's modified Miller's and Baume's classifications, respectively., The clinical examination involved measuring GR using William's periodontal probe and other parameters such as malocclusion, oral habits, and anomalies. GR was categorized as “slight” (0.5 or 1 mm) or “extensive” (1.5–3.5 mm). GR prevalence and its causative factors were the primary outcome measure, whereas oral hygiene index (OHI), malocclusion, and dmft scores were secondary outcome measures. Based on age, the study participants were divided into three groups (<7, 7–12, and >12). The associated factors, such as malocclusion, habits, and dental anomalies, were recorded.
Data were entered into the Microsoft Excel spreadsheet 2013. The statistical analysis was performed employing SPSS 17.0 version (Chicago, IL, USA). The GR between boys and girls and different age groups were compared along with the association of associated risk factors with GR. The Pearson's Chi-square test was performed for oral health parameters to derive the P, as this is a cross-sectional study. The dmft among oral health parameters was assessed using one-way ANOVA.
| Results|| |
Overall, 2095 children participated in the study, and the sample involved 1112 boys with a mean age of 9.58 years, whereas 983 were girls with a mean age of 9.61 years [Figure 1]. The overall mean DMFT/dmft was 1.4 ± 2, and OHI scores were 1.3 ± 0.4. The majority of the children were in the 7–12 years (49.3%) age group, followed by <7 years (28.6%) and >12 years (22.1%), the descriptive details are illustrated in [Figure 1]. The prevalence of GR among the study population was 7.9% (165) among girls reported, with a higher prevalence of 89 (9%) compared to boys, 76 (6.8%) as illustrated in [Figure 2]. The results were statistically not significant (P > 0.05). The GR prevalence was 5.8%, 11.9%, and 1.5% for age groups <7 years, 7–12 years, and >12 years, respectively (P < 0.05) as depicted in [Figure 3].
Among the children who participated in the study, 162 (7.7%) were observed with malocclusion (5.4%), deleterious habits (0.3%), and dental anomalies (2%), respectively [Figure 4]. In children with malocclusion, 5.5% (62) were males and 52 (5.2%) were females (P > 0.05). Malocclusion was 1.6% (10), 4.8% (42), and 13.3% (62) for <7 years, 7–12 years, and >12 years, respectively (P < 0.05). Deleterious habits were more common in females (0.5%) than males (0.08%). The findings were statistically nonsignificant (P > 0.05). Deleterious habits were 0.5% (3), 0.1% (2), and 0.4% (2) for <7 years, 7-12 years, and >12 years, respectively (P < 0.05). Dental anomalies were almost the same in males and females (2%); however, more in the 7–12 years age group (2.4%) than <7 years (1%) and >12 years (2.3%) with nonsignificant results (P > 0.05). The gender-based comparison of associated factors was summarized in [Table 1], and the age-based comparison was summarized in [Table 2]. Among children with malocclusion, 9 (7.9%) were noted with GR, whereas 7 (16.7%) with dental anomalies had GR. Surprisingly, no children with observed deleterious habits were diagnosed with GR. The GR was associated with dental anomalies (P < 0.05), whereas GR was not associated with associated factors such as malocclusion and deleterious habits (P > 0.5%) in terms of statistical significance. The details of the comparisons are summarized in [Table 3].
|Table 1: Association of gender with the incidence of malocclusion, deleterious habits, and dental anomalies|
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|Table 2: Association of age with the incidence of malocclusion, deleterious habits, and dental anomalies|
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|Table 3: Association of gingival recession with malocclusion, deleterious habits, and dental anomalies|
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| Discussion|| |
GR is a result of the apical migration of gingival tissues. Often, the GR results from a combination of various predisposing factors. Löe et al. support the concept of multiple predisposing factors in the GR etiology through parallel longitudinal studies. Detailed information on the prevalence of GR among children is expedient for two reasons. First, the research effort in gingival epidemiology has been focused on middle-aged or older people. Furthermore, the other reason is the lack of understanding of epidemiology. Clinical presentation earlier in the disease course may enable timely and appropriate interventions at both the clinical and population levels. Data from the present study determined the prevalence of GR in children. Checchi et al. Slutzkey and Levin and Nguyen-Hieu et al. reported that the GR is not typical in young adults, although its frequency increases with age. The present study results were in consensus with these studies. Gender variations in the prevalence of GR are attributable to the evidence that females visit dentists frequently and maintain good oral hygiene more than males. The prevalence of GR is higher in females than males, which disagrees with the studies conducted by Arowojolu and Toker and Ozdemir. However, it is not always feasible to compare the prevalence of disease reported by different studies due to differences in sampling and study design and the various classifications and diagnostic criteria used. Källestål et al. and Chrysanthakopoulos reported that the frequency of GR was higher in individuals with excellent oral hygiene and could be attributed to their vigorous toothbrushing to maintain good oral health. Kassab and Cohen and Daprile et al. noted that GR more frequently occurred in patients having good rather than poor oral hygiene. However, some authors, such as Susin et al., Sarfati et al., and Chrysanthakopoulos indicated that dental plaque, gingival inflammation, and calculus were significantly associated with root surface exposure. However, in the present study, the OHI scores were reasonably good, and the GR prevalence was 7.9%.
The prevalence of GR varies from 3% to 100%, depending on the population and analysis methods.,,, Mathur et al. reported an 18% prevalence of GR in 1800 Indian children of 10–15 of age. Younes and El Angbawi reported a 9.88% prevalence of GR among 1336 Arabin children aged 10–15 years. A British study reported 17% pseudo GR and 1% true GR in mandibular central incisors among 1036 children from mixed ethnic groups of age 15 years. However, the prevalence of GR was 7.9% in 2095 school children in the present study. The sample size of this study is comparatively more, and evaluation was not only confined to mandibular central incisors. Some studies have reported GR affecting at least one tooth or in one segment of the mouth, predominantly at buccal surfaces or according to characteristic patterns. A few earlier studies have even defined the exact measurements of GR.,,, The GR occurs in teenagers, and older individuals., The prevalence of GR appears to be lower in younger individuals where the incidence increased over a period.,,,,,,,, The GR was evident among individuals with excellent oral hygiene,,,, and those with no periodontal treatment. In a longitudinal study, 100 percent of Sri Lankans with poor oral hygiene had GR by age 40, whereas GR was less in Norwegians with good oral health. However, age stratification, measurement methods, and oral hygiene status may influence the reported prevalence of this condition. Most of the reported GR studies were performed on adults; however, the present study involved children.
The reported associated factors for GR were tooth movement by orthodontic forces, smoking, chemicals restorations, calculus, high frenal attachment, position of the tooth, improperly designed partial dentures, and improper tooth brushing. In the present study, none of these factors were addressed, which can be a potential limitation in the present study. The association between GR and malocclusion, habits, and dental anomalies was assessed in the present study. Among children with malocclusion, 7.9% (9 in 114) were reported with GR, whereas 16.7% (7 in 42) showed GR with dental anomalies. Surprisingly, none of the children observed deleterious habits diagnosed with GR. The GR was associated with dental anomalies (P < 0.05), whereas GR was not associated with associated factors such as malocclusion and deleterious habits (P > 0.5%) in terms of statistical significance. These findings are in disagreement with published studies.,, There was a growing concern among clinicians about an increase in GR in the pediatric population, and occasional observational studies are available in the literature regarding the prevalence of GR and its causative factors. Hence, the present study intended to evaluate the prevalence of GR and its causative factors in children. As the sample was recruited from the outpatient department and school dental camps, the present study's findings may not be generalized. The association between factors associated with GR has been evaluated; however, the association between GR and different habits, different malocclusion, and associated dental anomalies has not been analyzed. This is a potential limitation of the study. The evaluation of GR was done based on age, and dentition was assumed; however, it is essential to establish such pathologies based on dentition. This is another potential limitation of the study. Other etiological factors responsible for the causation of GR, such as deleterious oral habits, are to be recorded.
| Conclusion|| |
Within the study limitations, the prevalence of GR observed is 7.9% in the present study, and GR is more common in males and the 7–12 years of age group. The GR is associated with etiological factors such as malocclusion, dental anomalies, and deleterious habits. However, the exact relationship has not been clearly established, and further studies are recommended with extensive epidemiological data.
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Conflicts of interest
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| References|| |
Mythri S, Arunkumar SM, Hegde S, Rajesh SK, Munaz M, Ashwin D. Etiology and occurrence of gingival recession - An epidemiological study. J Indian Soc Periodontol 2015;19:671-5.
] [Full text]
Dodwad V. Etiology and severity of gingival recession among young individuals in Belgaum district in India. Annal Dent Univ Malaya 2001;8:1-6.
Sognnaes RF. Periodontal significance of intraoral friction ablation. J West Soc Periodontal Abstr1977;25:112-21.
Baker DL, Seymour GJ. The possible pathogenesis of gingival recession. A histological study of induced recession in the rat. J Clin Periodontol 1976;3:208-19.
Thompson NJ, Boyer EM. Validity of oral health screening in field conditions: Pilot study. J Am Dent Hyg Assoc 2006;80:1-10.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.
Mahajan A. Mahajan's modification of the miller's classification for gingival recession. Dent Hypotheses 2010;1:45-50. [Full text]
Baume LJ. Physiological tooth migration and its significance for the development of occlusion. I. The biogenetic course of the deciduous dentition. J Dent Res 1950;29:123-32.
Löe H, Anerud A, Boysen H. The natural history of periodontal disease in man: Prevalence, severity, and extent of gingival recession. J Periodontol 1992;63:489-95.
Checchi L, Daprile G, Gatto MR, Pelliccioni GA. Gingival recession and toothbrushing in an Italian School of Dentistry: A pilot study. J Clin Periodontol 1999;26:276-80.
Slutzkey S, Levin L. Gingival recession in young adults: Occurrence, severity, and relationship to past orthodontic treatment and oral piercing. Am J Orthod Dentofacial Orthop 2008;134:652-6.
Nguyen-Hieu T, Ha Thi BD, Do Thu H, Tran Giao H. Gingival recession associated with predisposing factors in young vietnamese: A pilot study. Oral Health Dent Manag 2012;11:134-44.
Arowojolu MO. Gingival recession at the University College Hospital, Ibadan-prevalence and effect of some aetiological factors. Afr J Med Med Sci 2000;29:259-63.
Toker H, Ozdemir H. Gingival recession: Epidemiology and risk indicators in a university dental hospital in Turkey. Int J Dent Hyg 2009;7:115-20.
Albandar JM, Muranga MB, Rams TE. Prevalence of aggressive periodontitis in school attendees in Uganda. J Clin Periodontol 2002;29:823-31.
Källestål C, Matsson L, Holm AK. Periodontal conditions in a group of Swedish adolescents. (I). A descriptive epidemiologic study. J Clin Periodontol 1990;17:601-8.
Chrysanthakopoulos NA. Aetiology and severity of gingival recession in an adult population sample in Greece. Dent Res J (Isfahan) 2011;8:64-70.
Kassab MM, Cohen RE. The etiology and prevalence of gingival recession. J Am Dent Assoc 2003;134:220-5.
Daprile G, Gatto MR, Checchi L. The evolution of buccal gingival recessions in a student population: A 5-year follow-up. J Periodontol 2007;78:611-4.
Susin C, Haas AN, Oppermann RV, Haugejorden O, Albandar JM. Gingival recession: Epidemiology and risk indicators in a representative urban Brazilian population. J Periodontol 2004;75:1377-86.
Sarfati A, Bourgeois D, Katsahian S, Mora F, Bouchard P. Risk assessment for buccal gingival recession defects in an adult population. J Periodontol 2010;81:1419-25.
Vehkalahti M. Occurrence of gingival recession in adults. J Periodontol 1989;60:599-603.
O'Leary TJ, Drake RB, Jividen GJ, Allen MF. The incidence of recession in young males: relationship to gingival and plaque scores SAM-TR-67-97. Tech Rep SAM-TR 1967:1-4.
O'Leary TJ, Drake RB, Crump PP, Allen MF. The incidence of recession in young males: A further study. J Periodontol 1971;42:264-7.
Sangnes G, Gjermo P. Prevalence of oral soft and hard tissue lesions related to mechanical tooth cleansing procedures. Community Dent Oral Epidemiol 1976;4:77-83.
Yoneyama T, Okamoto H, Lindhe J, Socransky SS, Haffajee AD. Probing depth, attachment loss and gingival recession. Findings from a clinical examination in Ushiku, Japan. J Clin Periodontol 1988;15:581-91.
Albandar JM, Kingman A. Gingival recession, gingival bleeding, and dental calculus in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999;70:30-43.
Gorman WG. Prevalence and etiology of gingival recession. J Periodontol l967;38:316-22.
Björn AL, Andersson U, Olsson A. Gingival recession in 15-year old pupils. Swed Dent J 1981;5:141-6.
Akpata ES, Jackson D. The prevalence and distribution of gingivitis and gingival recession in children and young adults in Lagos, Nigeria. J Periodontol 1979;50:79-83.
Joshipura KJ, Kent RL, DePaola PF. Gingival recession: Intra-oral distribution and associated factors. J Periodontol 1994;65:864-71.
Mathur A, Jain M, Jain K, Samar M, Goutham B, Swamy PD, et al
. Gingival recession in school kids aged 10-15 years in Udaipur, India. J Indian Soc Periodontol 2009;13:16-20.
] [Full text]
Younes SA, El Angbawi MF. Gingival recession in the mandibular central incisor region of Saudi schoolchildren aged 10-15 years. Community Dent Oral Epidemiol 1983;11:246-9.
Stoner JE, Mazdyasna S. Gingival recession in the lower incisor region of 15-year-old subjects. J Periodontol 1980;51:74-6.
Khocht A, Simon G, Person P, Denepitiya JL. Gingival recession in relation to history of hard toothbrush use. J Periodontol 1993;64:900-5.
Artun J, Krogstad O. Periodontal status of mandibular incisors following excessive proclination. A study in adults with surgically treated mandibular prognathism. Am J Orthod Dentofacial Orthop 1987;91:225-32.
Gunsolley JC, Quinn SM, Tew J, Gooss CM, Brooks CN, Schenkein HA. The effect of smoking on individuals with minimal periodontal destruction. J Periodontol 1998;69:165-70.
Quart AM, Small CB, Klein RS. The cocaine connection. Users imperil their gingiva. J Am Dent Assoc 1991;122:85-7.
Parma-Benfenali S, Fugazzoto PA, Ruben MP. The effect of restorative margins on the postsurgical development and nature of the periodontium. Part I. Int J Periodontics Restorative Dent 1985;5:30-51.
van Palenstein Helderman WH, Lembariti BS, van der Weijden GA, van 't Hof MA. Gingival recession and its association with calculus in subjects deprived of prophylactic dental care. J Clin Periodontol 1998;25:106-11.
Trott JR, Love B. An analysis of localized gingival recession in 766 Winnipeg High School students. Dent Pract Dent Rec 1966;16:209-13.
Nuvvula S, Ega S, Mallineni SK, Almulhim B, Alassaf A, Alghamdi SA, et al
. Etiological factors of the midline diastema in children: A systematic review. Int J Gen Med 2021;14:2397-405.
Wright PS, Hellyer PH. Gingival recession related to removable partial dentures in older patients. J Prosthet Dent 1995;74:602-7.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]