Οδοντική φθορά και περιοδοντική κατάσταση σε Ελληνικό πληθυσμό ενηλίκων

Abstract

Introduction: Tooth Wear (TW) is a cumulative surface loss of mineralized tooth substance due to physical or chemo-physical processes and it is irrelevant to dental caries, resorption, or trauma. It is a very prevalent phenomenon, having been considered as universal and irreversible and, furthermore, it may be regarded as the outcome of dental erosion, attrition, and abrasion, causing aesthetic and functional compromise. Increasing wear has been associated with age, and various other factors have been reported to influence its type and/or severity both in individuals and groups. Even though TW should not be attributed only to the ageing process, a general tendency towards increasing wear depending on age has been supported, with the latter being even more significant in senior citizens, since increased life expectancy, as well as, Preventive Dentistry considerations and dental restorative innovation procedures, might enhance the possibility of natural dentition retention among elderly populations. From a periodontal perspective, little evidence has been reported so far, regarding probable associations between periodontal status and TW. Early findings from studies evaluating tooth brushing and its effect on cervical wear, suggest that specific brushing techniques may enhance abrasion and hence provoke cervical wear. In a more recent study, clinical periodontal parameters, such as plaque index, probing pocket depth, gingival recession and tooth mobility, were assessed as influential factors on TW, in 30 adult patients. Cervical wear was detected to be significantly associated with less plaque accumulation and more shallow periodontal pockets. On the other hand, advanced gingival recession but absence of tooth mobility predisposes to deeper cervical lesions development. Nevertheless, cumulative tooth level or patient level TW, and not just the cervical component of it, has yet to be investigated regarding periodontal status in large community samples. Objective: The present observational study aims to determine the prevalence of TW in Northern Greece, and more specifically in two population clusters of Greek adults, aged 35-44 and 65-74 years. It attempts to provide assessments in both patient-level and surface level approach, as the severity and wear frequency of each tooth surface is about to be examined. Additionally, the present study evaluates patient-level associations between TW, periodontal condition and sociodemographic factors. Materials and Methods: A cross-sectional design was embraced, and a cluster sample was selected according to WHO guidelines for national pathfinder surveys. This design ensures the participation of a satisfactory size of people that may present different disease prevalence in the conditions that are being examined. In order comparison with previous national survey data to be more accurate, the sample was collected in the same manner and from the same geographical areas of Northern Greece, as in past national epidemiological studies, enrolling subjects from the metropolitan city of Thessaloniki, as well as from four Northern Greece counties (Evros, Ioannina, Kastoria, Larissa). The participant ages varied from 35 to 44 years for Group 1 and from 65 to 74 years for Group 2, resulting in a sample of 531 and 363 dentate individuals for Groups 1 and 2, respectively. Three dentists-examiners supported by their assistants examined the participants according to a field dentistry protocol. Prior to survey beginning, the examiners were trained and calibrated on the examined indices to reach a very good inter-examiner agreement (Kappa Coefficient >0.85). The primary recorded variable was a simplified version of Tooth Wear Index (TWI), which was recorded and processed in a surface-level and a patient-level analysis. Periodontal health was recorded with Community Periodontal Index (CPI) and presented as mean values per patient, as well as with an ordinal version of attachment loss (AL), introduced by WHO. Simplified Oral Hygiene Index was utilized in order plaque (DI) and calculus (CI) to be assessed and the scores were classified into three specific score-levels. Socio-demographic data, including gender, age, area, urban/rural location, educational level, and monthly income were collected through a structured questionnaire that was completed face-to-face at the time of the clinical examination. Finally, Group 1 participants were asked four questions (Q1-Q4) concerning some behavioral parameters. All statistical analyses were performed with the IBM SPSS statistics v.23.0 enhanced with the module Exact Tests for performing the Monte-Carlo simulation method. The significance level in all hypotheses and testing procedures was pre-determined at a = 0.05 (P ≤0.05). Results: Patient-level TW was detected to be a very common condition and especially in Group 2. Almost all the participants presented with some degree of TW. In both Groups, the incisal surfaces of anterior teeth were most frequently affected followed by the occlusal surfaces of mandibular and maxillary ones, especially of the first molars. For participants of Group 2, a statistically significant medium positive correlation has been detected between TWI and all periodontal health indices, except CPI. Spearman’s rho coefficient for DI was 0.25 (P <0.001), while the corresponding coefficient was 0.25 (P <0.001) and 0.21 (P <0.001) for CI and AL, respectively. Spearman’s rho correlation coefficient between TWI and age was 0.19 (P <0.001), indicating a weak positive correlation of TWI with the specific individual ages, within the examined age cluster. For the participants of Group 2, a statistically significant (P <0.001) medium positive correlation was detected between TWI and CPI. Furthermore, a significant (P <0.001) weak positive correlation was revealed concerning TW and the other periodontal indices examined, that is AL, CI and DI. Concerning the association of TW and age, a significant (P <0.001), weak positive correlation between TWI and the specific individual ages was also detected. In Group 1, significant differences in TW scores were found referring to gender, population type (urban or rural), educational level and among the different geographical regions having been investigated. However, these factors, apart from the participants’ gender, remained insignificant, in relation to TW scores, in Group 2. Conclusions: The present study is based on the presentation and analysis of cross-sectional data, which are consistent with high tooth wear prevalence in middle-aged adults and senior citizens in Northern Greece. Age and male gender were detected to be consistent with higher TW scores in senior citizens, while several sociodemographic factors, such as age, male gender, rural populations and lower educational level have been associated significantly with increased tooth wear in Greek adults, aged 35-44 years. Moreover, a positive correlation was identified between Tooth Wear Index and periodontal status, in both groups, in a patient level approach.

Σκοπός: Η διερεύνηση επιδημιολογικών χαρακτηριστικών της οδοντικής φθοράς (ΟΦ) σε πληθυσμό Ελλήνων ενηλίκων και η μελέτη ενδεχόμενων συσχετίσεων αυτής με την περιοδοντική κατάσταση, αλλά και με κοινωνικούς και δημογραφικούς παράγοντες. Υλικά και Μέθοδοι: Το αρχειακό υλικό της μελέτης αφορά σε δείγμα 894 ατόμων που ανήκουν στις ηλικιακές ομάδες ενοδόντων εθελοντών 35-44 ετών (Ομάδα Ι, Ν=531) και 65-74 ετών (Ομάδα ΙΙ, Ν=363), όλοι κάτοικοι Β. Ελλάδας, και οι οποίοι υποβλήθηκαν σε κλινική εξέταση και συμπλήρωση ερωτηματολογίου, σύμφωνα με το πρωτόκολλο του ΠΟΥ για Εθνικές τροχιοδεικτικές Έρευνες. Αξιολογήθηκε ο δείκτης TWI (Tooth Wear Index), αλλά και περιοδοντικοί δείκτες όπως ο δείκτης απώλειας πρόσφυσης (ΑL), ο CPI (Community Periodontal Index) και δείκτες σχετικά με την παρουσία μικροβιακής πλάκας (DI) και τρυγιακών εναποθέσεων (CI). Με τη χρήση ερωτηματολογίου καταγράφτηκαν κοινωνικά και δημογρα-φικά χαρακτηριστικά των υπό εξέταση Ομάδων. Η στατιστική ανάλυση, βασι-σμένη στους σκοπούς της μελέτης, έλαβε χώρα σε επίπεδο οδοντικής επιφά-νειας, αλλά και σε επίπεδο ατόμου. Αποτελέσματα: Η Οδοντική Φθορά (ΟΦ) μετρήθηκε σε περίπου 40.000 οδοντικές επιφάνειες που εξετάστηκαν στους εθελοντές και των δύο ομάδων. Από όλες τις επιφά-νειες, αυτές που εμφάνισαν τη μεγαλύτερη μέση ΟΦ ήταν οι κοπτικές των προσθίων δοντιών, με τις χαμηλότερες τιμές ΟΦ να καταγράφονται στις χειλικές επιφάνειες των άνω προσθίων. Στην Ομάδα Ι, εντοπίστηκε σημαντική θετική συσχέτιση του μέσου TWI και της περιοδοντικής κατάστασης, όπως αυτή καταγράφτηκε με τους μετρούμενους δείκτες ΑL, CPI, DI, CI, ενώ στην Ομάδα ΙΙ o δείκτης TWI συσχετίστηκε σημαντικά με τους δείκτες ΑL, DI και CI. Επι-πρόσθετα, ανευρέθηκε συσχέτιση του TWI με την ηλικία και το φύλο των εθε-λοντών σε αμφότερες τις ηλικιακές ομάδες. Συμπεράσματα: Η ΟΦ συνιστά διαδεδομένο φαινόμενο στις τάξεις των Ελλήνων μεσηλίκων και υπερηλίκων, με τους τελευταίους να παρουσιάζουν τουλάχιστον μία φθαρμένη οδοντική επιφάνεια σε σχεδόν καθολικό βαθμό. Η ΟΦ σχετίζεται σημαντικά με την περιοδοντική κατάσταση των συμμετεχόντων και στις δύο ηλικιακές ομάδες της μελέτης. Επίσης, το ανδρικό φύλο, και η επιμέρους αύξηση της ηλικίας των συμμετεχόντων αποτελούν παράγοντες συνδεδεμένους με επιδείνωση της ΟΦ.