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Original Research (Original Article) 


Ayoob Mutleb Alnafisah et al, 2020;4(3):711–717.

International Journal of Medicine in Developing Countries

A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim

Ayoob Mutleb Alnafisah1*, Turki Khalid Alharbi1, Pramod Punchiri Sadan2

Correspondence to: Ayoob Mutleb Alnafisah

*College of Dentistry, Qassim University, Burayadh, Saudi Arabia.

Email: Ayoub.alnafeesa [at] qudent.org

Full list of author information is available at the end of the article.

Received: 08 January 2020 | Accepted: 23 January 2020


ABSTRACT

Background:

Individuals with systemic illness often develop multiple coexisting problems arising from the consumption of medications. In chronic systemic conditions, such as cardiac diseases, respiratory disorders, hypertension and psychiatric illnesses, medications may cause xerostomia which could increase the risk of caries and periodontal diseases. Disabilities due to systemic illness could also affect the ability of the individual to carry out oral hygiene practices and might adversely affect the oral microbial flora. Therefore, this study aimed to determine the association between systemic illness and oral status among Saudi dental patients.


Methodology:

A retrospective analysis was conducted in the Dental Clinics at Qassim University, Saudi Arabia. All patients aged between 15 and 90 years seeking dental treatment were included. The clinical charts and records of 1,147 patients were collected and analyzed. The oral health status was assessed through the most commonly used indicators, including decayed/missing/filled (DMF) and modified decayed/missing/filled teeth (DMFT) indices, Sillness and Lowe indices for plaque formation and bleeding index were also assessed.


Results:

The results showed that oral health variables, such as plaque index and bleeding index, were significantly higher with baseline parameters, such as biographic, adverse habits, and systemic health variables. It also showed that the subjects with heart diseases, respiratory diseases, and diabetes had significantly increased DMFT scores.


Conclusion:

A definite association between systemic illness and oral health status of individuals existed, especially when age was taken into consideration.


Keywords:

Systemic diseases, oral health status, DMF index, plaque index, bleeding index.


Introduction

Periodontitis is the most common oral infection which is prevalent globally. It is considered to be a destructive inflammatory disease of the supporting tissues of the teeth caused by specific microorganisms. The primary etiology of periodontitis is dental plaque, which houses multiple bacteria of different strains and species. Clinically, it is manifested with bleeding gingiva, increase in probing depth, bad oral breath, and mobility of teeth. The detrimental effects of periodontitis are not confined to the oral cavity, but also have an impact on the systemic health of the individual. It had been proposed that periodontal diseases could have a modulating role in cardiovascular and cerebrovascular diseases, diabetes, and respiratory diseases.

Diabetes is a chronic metabolic disease which leads to a spike in the blood sugar levels. This condition if not controlled can damage other organs in the human body. Periodontitis is closely associated with the effects of diabetes based on its severity, even though not many studies have been conducted to this effect [1].

Coronary artery disease is commonly found in both men and women. The accumulation of plaque and cholesterol in the arterial vessels to the heart causes narrowing, resulting in less blood flow. Thus, there is a decrease in the blood flow to the heart muscle causing a heart attack. There were many studies which showed a link between periodontal diseases and coronary artery diseases [2]. Hypertension or an increase in the blood pressure level is one of the major risk factors for cardiovascular diseases. The most important factors leading to this condition are oxidative stress and endothelial dysfunction. Periodontitis, a chronic low-grade inflammation of gingival tissue, had been linked to endothelial dysfunction [3]. Chronic obstructive pulmonary disease (COPD) is a condition in which there is reduced airflow to the lungs leading to a chronic inflammatory response. Patients with such a respiratory disorder might find it difficult to maintain their oral health. Many studies point out to an association between COPD and periodontitis [4].

Osteoporosis is a systemic degenerative condition which leads to bone loss and subsequent fracture. Periodontitis also involves local inflammatory bone loss, resulting in tooth loss. The relation between the two has not been established [5]. Chronic kidney disease is the gradual and usually permanent reduction of the glomerular filtration rate of the kidneys, which leads to increase in the serum creatinine and blood urea nitrogen levels resulting in uremia. Oral manifestations of chronic renal disease are common during the progression of uremia [6].


Subjects and Methods

This retrospective analysis was carried out in the Dental Clinics at College of Dentistry of Qassim University, Buraydah, Saudi Arabia. The study population comprised adult males aged between 15 years and 90 years, selected from those who received dental treatment at the male campus of College of Dentistry, Qassim University, Saudi Arabia. The systemic health status was used from the data of the selected patients and the descriptive statistics for the variables were listed. The decayed/missing/filled (DMF) and Modified decayed/missing/filled teeth (DMFT) indices were used from the data of the selected patients to determine the dental caries prevalence [7,8]. The Silness and Low index was used from the data of the selected patients to assess the plaque prevalence [9,10]. The Ainamo and Bay index was used from the data to assess the gingival bleeding status [11].

The data from the patients selected was categorized into various groups according to their systemic illness status. DMFT scores and periodontal status was assessed and matched to the systemic illness status. The association of the DMFT, Communicty Periodontal Index scores and systemic illness was computed with Chi-square test. Z test of proportions was used for comparing between the healthy participants and non-healthy participants. Chi-square test was used to compare the categorical variables and the analysis of variance was used to compare the difference between the outcome variables. A p value of less than 0.05 was taken as significant (confidence interval: 95%). The data was analyzed using the Statistical Package for Social Sciences version 23.


Results

The current study included 1,147 male patients aged between 15 and 90 years. The mean age of the male patients was in between 20 and 29 years old (45.4%), and the majority of them doesnot smoke (79.3%) (Table 1).

It was found that none of the of patients had Acquired immunodeficiency syndrome (AIDS), and also majority of them did not showed any response to any of the variables such as (heart diseases, hypertension, respiratory diseases, osteoporosis etc.) exept small number that ranged between 1 to 7% of patients (Table 2).

Additionally, it was found that approximately half of the patients 49.7% (n = 570) had a film of plaque, and 516 of them had a moderare accumulation (45%), and the abundance of the plaque was very low with percentage of 3.5% (n = 40). Of 1,147 patients, 1,126 had bleeding 98.2% (Table 3).

Furthermore, the test of association between Oral health related variables (Plaque and Bleeding) was also observed with baseline parameters that is sociodemographic, adverse habit and systemic health related variables (Table 4).

Table 1. Sociodemographic characters and related adverse habit.

S. No Variable Frequency Percentage (%)
1. Gender Male 1147 100
Female 0 0
2. Age 15–19 years 43 3.7
20–29 years 521 45.4
30–39 years 259 22.6
40–49 years 134 11.7
≥50 years 190 16.6
3. Smoking Yes 237 20.7
No 910 79.3

Table 2. Systemic health status of the participants.

S.No Variables Frequency Percentage (%)
1. Heart disease Yes 14 1.2
No 1,133 98.8
2. Hypertension Yes 58 5.1
No 1,089 94.9
3. Respiratory disease Yes 38 3.3
No 1,109 96.7
4. Osteoporosis Yes 1 0.1
No 1,146 99.9
5. Neurological disease Yes 4 0.3
No 1,143 99.7
6. Epilepsy Yes 4 0.3
No 1,143 99.7
7. Liver disease Yes 5 0.4
No 1,142 99.6
8. Kidney disease Yes 3 0.3
No 1,144 99.7
9. Diabetes mellitus Yes 79 6.9
No 1,068 93.1
10. AIDS Yes 0 0
No 1,147 100

Table 3. Oral health status of the participants.

S.No Variables Frequency Percentage (%)
1 Plaque index No plaque 21 (1.8) 1.845
Film of plaque 570 (49.7) 49.7
Moderate accumulation 516 (45) 45
Abundance of plaque 40 (3.5) 3.5
2 Bleeding index No bleeding 21 (1.8) 1.8
Bleeding 1,126 (98.2) 98.2
3 DMFT index Mean ± SD 17.41±7.30
Min 1
Max 31
Range 31
Standard Error Mean (SEM) 7.34

While associating the Plaque Index, it was found that subjects of age group ≥50-year old had a significant (p < 0.001) increase in the prevalence of “abundance of plaque” (12.6%) when compared with other age groups (15–19 = 0%, 20–29 = 2.1%, 30–39 = 1.5%, and 40–49 = 0.7%). Patients who were smoking showed significantly (p < 0.001) increased prevalence of “abundance of plaque” (5.9%) when compared with non-smokers (2.9%). Patients who had Heart diseases showed a significant (p < 0.001) increased prevalence of “abundance of plaque” (21.4%) when compared with subjects with no Heart disease (3.3%). Patients who had hypertension showed significantly (p < 0.001) increased prevalence of “abundance of plaque” (13.8%) when compared with non-hypertensive patients (2.9%). Patients who had Liver diseases showed a significant (p < 0.001) increased prevalence of “abundance of plaque” (40%) when compared with patients with no Liver disease (3.3%). Also, patients who had Kidney disease showed significant (p < 0.05) increased prevalence of “abundance of plaque” (33.3%) when compared with patients with no Kidney disease (3.4%). Additionally, a significant increment in the prevalence of “abundance of plaque” (13.9%) was shown for diabetic patients (p < 0.001) when compared with non-Diabetic patients (2.7%).

Table 4. Association between oral health related variables (Plaque and Bleeding) with baseline parameters.

S. No. Baseline parameters Oral health related variables
Plaque index Bleeding index
1 Age 0.000* 0.000*
2 Smokin 0.000* 0.46
3 Heart disaese 0.000* 0.60
4 Hypertension 0.000* 0.28
5 Respiratory disease 0.44 0.39
6 Osteoporosis 0.74 0.89
7 Neurological disease 0.17 0.78
8 Epilepsy 0.78 0.78
9 Liver disease 0.000* 0.76
10 Kidney disease 0.04* 0.81
11 Diabetes 0.000* 0.69

*Significant p-value.

Table 5. Analysis of oral health DMFT Index with baseline parameters.

S.No Baeline parameters Frequency N (%) Mean ± SD p value
[one way analysis of variance (ANOVA)]
1 Age 15–19 years 43 10.30 ± 6.159 0.000*
20–29 years 521 17.90 ± 7.121
30–39 years 259 16.98 ± 6.888
40–49 years 134 16.61 ± 6.984
≥ 50 years 190 18.85 ± 8.042
2 Smoking Yes 237 19.23 ± 6.851 0.000*
No 910 16.94 ± 7.393

*Significant p-value.

In addition, when associating bleeding Index it was shown that patients who were aged ≥50-year old showed a significant (p < 0.001) increased prevalence of “presence of bleeding” (100%) when compared with other age groups (15–19 = 88.4%, 20–29 = 98.5%, 30–39 = 98.1%, and 40–49 = 97.8%).

When the association between Oral health related variable (DMFT Index) was observed with baseline parameters—sociodemographics and adverse habit related variables. It was found that patients who were aged ≥50-year old showed a significant (p < 0.001) increment of “DMFT Score” when compared with other age groups. In addition, patients who were smoking showed a significant (p < 0.001) increased “DMFT Score” when compared with non-smokers patients (Table 5).

When the association between Oral health related variable (DMFT Index) was observed with Systemic health related variables. It was found that patients who had Heart Disease showed a significant (p < 0.05) increase of DMFT Score when compared with others with no Heart disease. Also, patients who had respiratory disease showed a significant (p < 0.01) increase of “DMFT Score” when compared with patients with no respiratory disease. Finally, diabetic patients showed a significant (p < 0.05) increase of “DMFT Score” when compared with non-Diabetic (Table 6).


Discussion

Oral diseases such as periodontitis was found to had an impact on a huge number of population [12]. Chronic diseases have been associated with dental diseases and tooth loss [13]. Individuals with systemic illness often developed multiple problems that arise from more consumption of medications. In chronic systemic conditions, such as cardiac diseases, respiratory disorders, hypertension and psychiatric illnesses, medications may cause xerostomia which could increase the risk of caries and periodontal diseases [14].

In the present study, the oral health status and the systemic health status of 1,147 patients was compared. It was found that the prevalence of “abundance of plaque” was showed a highly significant (p value < 0.001) increment with the age group ≥ 50 years, smoking, heart diseases, hypertension, liver diseases, and diabetes. While the prevalence of “abundance of plaque” was significantly (p value < 0.05) increased with Kidney diseases.

Table 6. Analysis of oral health DMFT index with systemic health related variables.

S. No Baeline parameters Frequency N (%) Mean ± SD P value
(One Way ANOVA)
1. Heart disease Yes 14 (1.2) 21.57 ± 7.763 0.03*
No 1,133 (98.8) 17.36 ± 7.323
2. Hypertension Yes 58 (5.1) 19.07 ± 8.373 0.07
No 1,089 (94.9) 17.33 ± 7.274
3. Respiratory disease Yes 38 (3.3) 14.29 ± 7.071 0.008
No 1,109 (96.7) 17.52 ± 7.328
4. Osteoporosis Yes 1 (0.1) 21.00 ± 0 0.62
No 1,146 (99.9) 17.41 ± 7.342
5. Neurological disease Yes 4 (0.3) 21.75 ± 8.180 0.23
No 1,143 (99.7) 17.40 ± 7.336
6. Epilepsy Yes 4 (0.3) 11.50 ± 9.539 0.10
No 1,143 (99.7) 17.43 ± 7.328
7. Liver disease Yes 5 (0.4) 22.80 ± 8.379 1
No 1,142 (99.6) 17.39 ± 7.330
8. Kidney disease Yes 3 (0.3) 22.67 ± 11.372 0.21
No 1,144 (99.7) 17.40 ± 7.329
9. Diabetes mellitus Yes 79 (6.9) 19.19 ± 8.324 0.02*
No 1,068 (93.1) 17.28 ± 7.249

* & € Significant p-value.

The current result was in agreement with the observation of Grenkjer [15] who said that prolonged retention of food particles in the oral cavity might result in dental plaque. Also, it was reported previously that the risk of periodontits was increased with the age of populations so there was increased prevalence of periodontal disease among elderly adults [16]. It was also concluded that diseases, such as cardiovascular disorders, diabetes mellitus with and without cardiovascular pathologies, and bone/joint disorders negatively impact oral hygiene. Greatest loss of teeth and higher indices were observed in these patients [17].

In the present study, it was shown that the prevalence of “presence of bleeding” (100%) was highly significant in the age group of patients ≥ 50 (p < 0.001), and the same age group showed a significantly (p < 0.001) increased “DMFT Score” when compared from other age groups. Additionally, patients who smoked showed a significant (p < 0.001) increased of “DMFT Score” when compared with non-smokers. While, patients who had Heart disease, and diabetics also showed a significant increased of DMFT Score and p value was <0.05. Finally, patients who had a respiratory disease showed a significant increased of “DMFT Score” at p value < 0.01. These results were similar to that reported by Abnet [18] who stated that higher DMFT indices was correlated with a high risk of esophageal squamous cell carcinoma. While, the current result was in contrary to that was reported by Sakai [19] who reported that DMFT indices were significantly lower in digestive system cancer patients. These results were in harmony with the result of Petersen [12] who reported that patients with poor oral health had epilepsy. Costa et al. [14] stated that patients with epilepsy had an increased likelihood of having poor oral hygiene, gingivitis and periodontitis. Also, Keshava et al. [20], observed that periodontitis could lead to progression of Alzheimer's disease (AD) and inflammation that known to play a pivotal role in this process [20]. Also, Nazir [21], concluded that the periodontal disease is the most prevalent infectious condition and that reduction in the incidence and prevalence of periodontal diseases could result in the lowering of associated systemic diseases and complications. Oluwagbemigun et al. [22] added that the number of periodontal diseases were specifically associated with myocardial infarction and not with other chronic diseases, indicating that dental status further strengthens the link between oral health and cardiovascular diseases.

Therefore, it was suggested that a well-designed large-scale longitudinal studies are required to determine whether causal links exist, the strengths of those links and the optimum timing and types of treatment to reduce risks [23], and to increase the importance of considering multiple risk factors, including periodontal status, because this improves the identification of individuals at high risk for chronic kidney disease and may ultimately reduce its burden [24].


Conclusion

It was concluded that age and habits could influence the DMFT index, plaque index, and bleeding index. It could also be concluded that systemic conditions, such as heart diseases, hypertension, diabetes, respiratory disorders, kidney diseases, and liver diseases have significantly increased DMFT, plaque, and bleeding scores on their respective indices.


List of Abbreviations

COPD Chronic obstructive pulmonary disease
DMF Decayed/missing/filled
DMFT Modified decayed/missing/filled teeth

Conflict of interest

The authors declared that there is no conflict of interest regarding the publication of this case report.


Funding

None.


Consent of publication

Informed consent was obtained from all participants.


Ethical approval

The ethical approval was obtained from Qassim University, College of Dentistry with ethical approval number INT/701/2018.


Author details

Ayoob Mutleb Alnafisah1, Turki Khalid Alharbi1, Dr.Pramod Punchiri Sadan2

  1. College of dentistry, Qassim University, Burayadh, Saudi Arabia
  2. Department of Prosthetic Dental Sciences, Qassim University, Burayadh, Saudi Arabia

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How to Cite this Article
Pubmed Style

Alnafisah AM, Alharbi TK, Sadan DP. A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim. IJMDC. 2020; 4(3): 711-717. doi:10.24911/IJMDC.51-1578309445


Web Style

Alnafisah AM, Alharbi TK, Sadan DP. A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim. http://www.ijmdc.com/?mno=80822 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1578309445


AMA (American Medical Association) Style

Alnafisah AM, Alharbi TK, Sadan DP. A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim. IJMDC. 2020; 4(3): 711-717. doi:10.24911/IJMDC.51-1578309445



Vancouver/ICMJE Style

Alnafisah AM, Alharbi TK, Sadan DP. A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim. IJMDC. (2020), [cited March 29, 2020]; 4(3): 711-717. doi:10.24911/IJMDC.51-1578309445



Harvard Style

Alnafisah, A. M., Alharbi, . T. K. & Sadan, . D. P. (2020) A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim. IJMDC, 4 (3), 711-717. doi:10.24911/IJMDC.51-1578309445



Turabian Style

Alnafisah, Ayoob Mutleb, Turki Khalid Alharbi, and Dr.Pramod Punchiri Sadan. 2020. A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim. International Journal of Medicine in Developing Countries, 4 (3), 711-717. doi:10.24911/IJMDC.51-1578309445



Chicago Style

Alnafisah, Ayoob Mutleb, Turki Khalid Alharbi, and Dr.Pramod Punchiri Sadan. "A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim." International Journal of Medicine in Developing Countries 4 (2020), 711-717. doi:10.24911/IJMDC.51-1578309445



MLA (The Modern Language Association) Style

Alnafisah, Ayoob Mutleb, Turki Khalid Alharbi, and Dr.Pramod Punchiri Sadan. "A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim." International Journal of Medicine in Developing Countries 4.3 (2020), 711-717. Print. doi:10.24911/IJMDC.51-1578309445



APA (American Psychological Association) Style

Alnafisah, A. M., Alharbi, . T. K. & Sadan, . D. P. (2020) A retrospective analysis of the association between systemic illness and oral status among the Saudi Arabian sub population of Qassim. International Journal of Medicine in Developing Countries, 4 (3), 711-717. doi:10.24911/IJMDC.51-1578309445