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 Table of Contents  
ORIGINAL RESEARCH
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 18-23

Prevalence of anterior gingival recession and related factors among Saudi adolescent males in Abha City, Aseer Region, Saudi Arabia


Department of Oral Medicine and Periodontology, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt, and Division of Periodontics, Department of Preventive Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia

Date of Web Publication31-Jan-2014

Correspondence Address:
Hossam E Eid
Department of Oral Medicine and Periodontology, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt, and Division of Periodontics, Department of Preventive Dental Sciences, College of Dentistry, King Khalid University, Abha, Kingdom of Saudi Arabia

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3172.126160

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  Abstract 

Background: Gingival recessions (GR) are asymptomatic and develop slowly, it can be localized or generalized, and be associated with one or more surfaces. Age is a variable that several authors have found associated with gingival recession. This study aimed to evaluate gingival recession clinically and related variables in a population of Saudi adolescent males, Southwestern of Saudi Arabia. Materials and Methods: A cross-sectional study was carried out on 250 Saudi adolescent males aged between 12 and 18 years. All periodontal clinical examinations were assessed using University of Michigan '0' probe with William's markings, a dental chair and one examiner. Questionnaires were used to collect diverse risk-related factors. Statistical analysis of the results was accomplished using Chi-square test (α = 0.05). Results: Out of 250 patients, 73.00% ± 8.97% were presented with gingival recession (GR) and 27.00% ± 4.11% without GR. The highest number 56 (22.4%) of patients were presented with GR and 8.4% without GR in the age group of 14 years. Then chronologically, 17.6% and 9.6%, 16.4% and 0.4%, 12.4% and 1.6%, and 0.8% and 0% patients were evident with and without GR of 15-, 17-, 16- and 18-years age groups, respectively. 22.25% ± 42.52% patients had GR in the upper left central incisors. Whereas, 17.25% ± 15.52%, 11.75% ± 17.48%, and 1.5% ± 1.91% patients were presented with GR in upper right central incisors, upper-left lateral incisors and upper-right lateral incisors, respectively. 50.4% ± 3.63% and 1.2% ± 0.31% having or not GR, respectively, who were not cleaning teeth at all. Toothbrush users had GR 28.8% ± 4.52% and 18% ± 2.84% without GR. Miswak and both aids users had or not GR were 18.8% ± 3.35%, 0.4% ± 0.15%, and 3.2% ± 0.49% and 4.4% ±1.13%, respectively. (51.6% ± 7.29%) of patients had GR without anterior crowding rather than the patients with anterior crowding (21.2 ± 3.49%). The highest percentage (38.4% ± 5.95%) of patients had GR having normal frenal attachments (Grade 0), whereas, in Grade 2, 1, and 3, patients had GR 34.8% ± 4.68%, 23.6% ± 3.08%, and 13.6% ± 2.20%, respectively. Interestingly, GRs were present in all patients who had habits of both smoking and tobacco use (8.4% ± 2.83%). Conclusion: The results of this study proved that neglecting oral hygiene is the most common cause behind increase the gingival recession among adolescents.

Keywords: Gingival recession, Adolescents, Saudi Arabia, southwestern region


How to cite this article:
Eid HE. Prevalence of anterior gingival recession and related factors among Saudi adolescent males in Abha City, Aseer Region, Saudi Arabia. J Dent Res Rev 2014;1:18-23

How to cite this URL:
Eid HE. Prevalence of anterior gingival recession and related factors among Saudi adolescent males in Abha City, Aseer Region, Saudi Arabia. J Dent Res Rev [serial online] 2014 [cited 2019 Dec 10];1:18-23. Available from: http://www.jdrr.org/text.asp?2014/1/1/18/126160


  Introduction Top


Gingival recession is the exposure of the root surface resulting from migration of the gingival margin apical to the cementoenamel junction (CEJ). It may be localized or generalized and can be associated with one or more tooth surfaces. [1] The etiology of the condition is multifactorial and may include plaque-induced inflammation, calculus and restorative iatrogenic factors, trauma from improper oral hygiene practices, tooth malpositions, high frenum attachment, improper periodontal treatment procedures, and uncontrolled orthodontics movements. [2],[3]

Epidemiological studies show that more than 50% of subjects in the populations studied have one or more sites with recession of at least 1 mm, buccal sites being most commonly affected. Higher levels of recession have been found in males than females. [4] Recession at the buccal surfaces is common in populations with good oral hygiene [5],[6],[7]] whereas with poor standards of oral hygiene it may affect other tooth surfaces. [8] Gingival recession at the lingual surfaces of lower anterior teeth showed a strong association with the presence of supragingival and subgingival calculus. [9]

Even though gingival recession may occur without any symptoms it can give rise to pain from exposed dentine, patient concern about loss of the tooth, poor esthetics or root caries. The denuded root surfaces cause deterioration in the esthetic appearance, dentin hypersensitivity, and inability to perform proper oral hygiene procedures. [10],[11] A relatively high prevalence of gingival recession among adults in Tanzania has been reported. [12],[13] Gingival recession on buccal surfaces has been ascribed to brushing habits. [13],[14],[15] Since the lingual surfaces in the Tanzanian population exhibits gingival recession to the same extent as the buccal surfaces, [12],[13] then it is doubtful that the Miswak is the cause of high prevalence of gingival recession. [14],[15],[16],[17] Younes and El-Angbawi reported that about 22% of the Saudi schoolchildren with gingival recession used Miswak. [18] The low percentage of calculus deposits found in the group affected by gingival recession may be due to the common use of Miswak. [14],[15],[16],[17] It has been reported that Miswak users had significantly more sites of gingival recession than did the toothbrush users. Furthermore, the severity of the recession was significantly more pronounced in the Miswak users than that in the toothbrush users. [14],[15],[16],[17] However, the gingival recession reported in Miswak users may be a reflection of poor techniques. [18],[19],[20] This study was performed in Abha city, Aseer region, southwestern Saudi Arabia which extends from the high mountains of Sarawat (with an altitude of 3,200 m above the sea level) to the Red Sea; this unique area of the world is characterized by population using Miswak besides tooth brushing side by side in oral hygiene maintenance which gave us a good chance to study the effect of Miswak on gingival recession with the other parameters of our study. This study has important limitations because the sample was not randomly selected from the Saudi population but consisted of patients that visited a private dental practice for their regular dental follow-up in college of dentistry, KKU. Up to our knowledge similar studies have not been carried out in the Abha city, Aseer region, due to which data from the present study are only comparable to those reported for similar studies that were carried out in other countries and in other cities of the Saudi Arabia.

Aim of the study

The study aimed to determine the most common causative factors and prevalence of gingival recession among Saudi adolescent males aged between 12 and 18 years in Abha city, Aseer region of Saudi Arabia.


  Materials and Methods Top


A cross-sectional study was carried out on (250) Saudi adolescent males; the males were examined in the dental clinics, college of Dentistry, KKU, Abha city of Saudi Arabia. Verbal consent for data collection obtained from the individuals who participated in the study through questionnaire approved from ethical research committee of college of Dentistry, KKU. Data were collected from February, 2013 to June 10, 2013. Dental examinations were carried out using interchangeable plane mouth mirrors and University of Michigan '0' probe with William's markings were used to measure the clinical crown length of the affected and adjacent teeth. Volchansky and Cleaton Jones stated that the clinical crown height is an objective measure of the position of gingival margin which could be used in determining the 'normal position' of the gingival margin. [21] Measurements were made at the labial midline from the gingival crest to the cementoenamel junction (CEJ). Periodontal diseases were indexed as plaque index (PI), gingival index (GI), calculus index (CI), and clinical attachment loss (CAL) after Loe [22] and modified from Russel. [23]

For anterior crowdings, the position of each mandibular central incisor was classified according to its relationship to the regular curve of the arch as described by Stoner and Mazdyasma where 0 = correctly positioned or instanding and 1 = tooth was labially placed or absent. [24] Frenal involvements in the affected and adjacent teeth were recorded according to the classification of Powell and McEniery, accordingly, 0 = no frenal involvement, 1 = frenal insertion close to the gingival margin but no retraction of gingiva, 2 = narrow frenal insertion with retraction of gingiva, 3 = broad frenal insertion with retraction of gingiva. [25]

Data analysis

Statistical analysis of the results was accomplished using Chi-square test (α =0.05).


  Results Top


Out of 250 patients, 73.00% ± 8.97% were presented with gingival recession (GR) and 27.00% ± 4.11% without GR.

[Table 1] showed that among 250 patients, the majority (30.8%) of the patients were examined under 14-, 15-, 17-, 16- and 13-years age groups. Only 2.4% and 0.8% patients were examined under the age groups of 12- and 18-years, respectively. The highest number 56 (22.4%) of patients were presented with GR and 8.4% without GR in the age group of 14 years. Then chronologically, 17.6% and 9.6%, 16.4% and 0.4%, 12.4% and 1.6%, and 0.8% and 0% patients were evident with and without GR of 15-, 17-, 16- and 18-years age groups, respectively. Twelve and 13-years age groups showed 1.6% of each having GR and 0.8% and 6.4% without GR, respectively.
Table 1: Age-wise frequencies of gingival recession


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[Figure 1]a showed that 22.25% ± 42.52% patients had GR in the upper-left central incisors. Whereas, 17.25% ± 15.52%, 11.75% ± 17.48%, and 1.5% ±1.91% patients were presented with GR in the upper-right central incisors, upper-left lateral incisors, and upper-right lateral incisors, respectively. GR were not evident in any patients in either canine of upper jaws. On the other hand, [Figure 1]b is presenting that majority (20.25% ± 24.20%) of the patients had GR in the lower right central incisors. The lower-left incisors, lower-right and left canines, lower-right lateral incisors and lower-left lateral incisors having GR 10.25% ± 15.48%, 3.0% ± 5.35% and 3.0 ± 4.08%, 2.5 ± 2.38% and 2.0 ± 3.37%, respectively.
Figure 1: Tooth-wise frequencies of gingival recession N.B.: UR1: Upper-right central incisor, UR2: Upper-right lateral incisor, UR3: Upper-right canine, UL1: Upper-left central incisor, UL2: Upper-left lateral incisor, UL3: Upper-left canine, LR1: Lower-right central incisor, LR2: Lower-right lateral incisor, LR3: Lower-right canine, LL1: Lower-left central incisor, LL2: Lower-left lateral incisor, LL3: Lower-left canine

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[Figure 2] presented with the majority (46% ± 6.81%) of the patients were cleaning their teeth using toothbrush, whereas, 22% ± 3.43%, Miswak and 4.8% ± 1.10% were using both (toothbrush and Miswak) aids. A considerable number of patients (26.4% ± 3.63%) were not cleaning their teeth at all.
Figure 2: Tooth cleaning methods (aids)

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[Figure 3] is showing that the 50.4% ± 3.63% and 1.2% ± 0.31% having or not GR, respectively, who were not cleaning teeth at all. Toothbrush users had GR 28.8% ± 4.52% and 18% ± 2.84% without GR. Miswak and both aids users had or not GR were 18.8% ± 3.35%, 0.4% ± 0.15% and 3.2% ± 0.49% and 4.4% ± 1.13%, respectively.
Figure 3: Tooth cleaning methods (aids) and GR

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[Figure 4] is presenting the fact that more numbers (51.6% ± 7.29%) of patients had GR without anterior crowding rather than the patients with anterior crowding (21.2% ± 3.49%). In the absence of anterior crowding, patients without GR (14.8% ± 2.28%) had slightly more (12.4% ± 2.61%) than with anterior crowding.
Figure 4: Relationship of anterior crowding and GR

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[Figure 5] showed that the highest percentage (38.4% ± 5.95%) of patients had GR having normal frenal attachments (Grade 0), whereas, in Grade 2, 1, and 3, patients had GR 34.8% ± 4.68%, 23.6% ± 3.08% and 13.6% ± 2.20%, respectively.
Figure 5: Relationship of frenal attachment gradings and GR

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In [Figure 6], the majority of the patients had GR 39.2% ± 5.11% having frenal positions on the lower lateral incisors and 29.6% ± 8.29% GR where the frenal positions were normal. In other cases, chronologically GR were found 14.4% ± 2.71% in upper lateral incisors, 13.6% ±2.20% in upper central incisors, 8.4% ± 1.4% in lower central incisors, 2.8% ± 1.06% in upper canines and 0.8% ± 0.2% in lower canines.

[Figure 7] showed the personal habits of the patients and the occurrences of GRs. Only smokers (13.2% ± 1.83%) had GR 7.2% ± 1.13% and 6.0% ± 1.02% had no GR. Among the tobacco users (8.8% ± 1.72%), 8.0% ± 1.59%, and 0.8% ± 0.2% had GR and no GR, respectively. Interestingly, GRs were present in all patients who had habits of both smoking and tobacco use (8.4% ± 2.83%).
Figure 6: Relationship of frenal attachment positions and GR N.B.: 0 (%)-normal frenal position

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Figure 7: Habits and GR

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  Discussion Top


Localized gingival recession occasionally presents a problem in adolescents and there is some confusion regarding the etiology and pathogenesis of such defects. [14],[15],[16],[17],[18],[19] Marginal tissue recession can cause major functional and esthetic problems. Interproximal recession creates space in which plaque, food, and bacteria can accumulate. [10],[11] Hyperemia of the pulp and associated symptoms may also result from exposure of the root surface. [20],[25] Periodontal health can be evaluated through different indicators including gingival recession [26] Its etiology is determined by a number of predisposing and precipitating factors. [26],[27] Predisposing factors may be anatomical or associated with occlusal trauma. The anatomical include poorly adhered gingiva, tooth malposition and crowding, root prominence, and bone defects. Those associated with occlusal trauma are related to the intensity and duration of trauma. In contrast, precipitating factors are a series of sociodemographic, socioeconomic, and environmental issues. Some studies have observed that gingival recession was associated with sex, number of teeth present, bleeding on probing (BOP), the presence or absence of systemic disease(s), use of dentures, and use of alcohol and tobacco, [27] or with inflammation measurements such as presence of plaque. [28] Pires et al. [29] reported that the presence of gingival recession in the anterior lingual mandibular region of a young population was associated with the use of piercings, age, male gender, and BOP. According to the results of this study proved that gingival recession is multifactorial condition, the highest number 56 (22.4%) of patients were presented with GR and 8.4% without GR in the age group of 14 years, which may be due to neglecting oral hygiene at this age group. 22.25% ± 42.52% patients had GR in the upper-left central incisors. Whereas, 17.25% ± 15.52%, 11.75% ± 17.48%, and 1.5% ± 1.91% patients were presented with GR in upper-right central incisors, upper-left lateral incisors, and upper-right lateral incisors, respectively, which may be due faulty brushing that exerts detrimental forces on marginal gingiva with subsequent gingival recession. Miswak and both aids users had or not GR were 18.8% ± 3.35%, 0.4% ± 0.15% and 3.2% ± 0.49% and 4.4 ± 1.13%, respectively (51.6 ± 7.29%) of patients had GR without anterior crowding rather than the patients with anterior crowding (21.2% ± 3.49%). The highest percentage (38.4% ± 5.95%) of patients had GR having normal frenal attachments (Grade 0), whereas, in Grade 2, 1 and 3, patients had GR 34.8% ± 4.68%, 23.6% ± 3.08%, and 13.6% ± 2.20%, respectively. Interestingly, GRs were present in all patients who had habits of both smoking and tobacco use (8.4% ± 2.83%). The results of this study similar in some of its aspects to a study done by Younes, Angbawi [18] who stated that Incidence of gingival recession in the mandibular central incisor region was examined in a sample of 1336 male and female Saudi school children aged between 10 and 15 years. Gingival recession was found in 9.88% with no significant difference in the affected teeth by age (P greater than 0.8361). There was a significant difference in the mean clinical crown length between the affected and adjacent teeth (P less than 0.0001). The highest significant association of gingival recession was found with inflammation (P less than 0.0001), anterior crowding (P less than 0.0009) and frenal involvement (P less than 0.0001). Another recent study by Chrysanthakopoulos [30] said that gingival inflammation, as determined by the gingival index, and smoking were the most important associated risk factors of GR. Turkish recent study by Toker, Ozdemir [31] concluded that high level of gingival recession in this population is significantly associated with a high level of dental plaque and calculus, male gender, smoking duration, tooth brushing frequency, traumatic tooth brushing and high frenum. The majority of studies including the recent ones reach to the same conclusion in all age groups of population about the most causative factor of gingival recession is the bad oral hygiene besides other causative factors as teeth crowding, frenal attachment, tooth brushing, bad oral habits to a lesser extent.


  Conclusion Top


The results of this study proved that neglecting oral hygiene is the most common cause behind increase the gingival recession among adolescents. The designation of educational program for periodontal health care is mandatory to decrease the risk of gingival recession among population specially the adolescents.


  Acknowledgement Top


The Author express their gratitude and acknowledgement to Dr. Nazar Omer Abdallah, Asst. Professor, Dept. of Business Administration, College of Community, KKU for his cordial assistance in analyzing the data.

 
  References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1]


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