Gingival recession; occurrence, severity and associated factors among patients attending dental clinics in Dar es salaam, Tanzania.

Abstract

Background Gingival recession refers to the vertical shift of the gingival margin from the crown of the tooth leading to the exposure of the root of the tooth, measured from the cementoenamel junction (CEJ) apically to where the gingival margin is at its maximum height. Gingival recession is a multifactorial problem arising mainly from periodontal diseases and mechanical factors of tooth brushing. Gingival recession is becoming a more prominent condition in different populations and it is becoming a big problem globally. It is a common problem in adults and adolescents. Its prevalence varies from 3% to 100% depending on the type of study, study population and methods used for analysis. In Tanzania few studies conducted on gingival recession have shown that the recession is evident among populations. Gingival recession interferes with dental aesthetic appearance. This aesthetic problem is more embarrassing in females than in males. Not only is it causing aesthetic problem but also lead to dentine hypersensitivity and increased susceptibility for root caries. Gingival recession is a preventable oral problem that if treated can drastically reduce discomfort and cost of treatment. This can be achieved by providing interventions to people/community based on the cause and associated factors that lead to the development of gingival recession.

Aim The aim of this study was to determine the prevalence of gingival recession, its severity and associated factors among patients attending dental clinics at Muhimbili National Hospital and Temeke Municipal Hospital in Dar es Salaam region.

Methodology This was a hospital based cross sectional descriptive study conducted in the dental clinics at Muhimbili National Hospital and Temeke Municipal Hospital between July and November 2012. A sample of 339 subjects, 168 male and 171 female subjects, aged 18 years and above were interviewed using a self administered questionnaire on oral hygiene behaviour, knowledge of cause and symptoms of periodontal disease. This was followed by full mouth examination to assess the presence of gingival recession in mm, presence or absence of gingival bleeding on gentle probing, plaque, calculus and periodontal pocket depth in mm at six points for each tooth. Data analysis was done by using SPSS version 16.0 and the statistical level of significance was p value < 0.05.

Results The overall prevalence of the gingival recession ≥1mm was 63.1%, the gingival recession was significantly higher in male (70.8%) than in female subjects (55.6%) (p value 0.004). The gingival recession of ≥3mm tends to increase with age (1.6% of the subjects in 18 – 34 years age group had recession of ≥3mm as compared to the 11.8% of the subjects in 65 + years age group). The lower jaw had more sites with gingival recession (61.1% of the subjects) as compared to the upper jaw (22.4% of the subjects). The buccal surfaces were more affected by the recession than the lingual/palatal surfaces (61.1% subjects were found to have gingival recession on the buccal surface and 48.7% subjects had gingival recession on the lingual/palatal surface). Age and periodontal diseases were found to be the significant contributors to the development of the gingival recession. The tooth cleaning device and toothbrushing techniques were not significantly associated with the gingival recession.

Conclusion This study has shown that gingival recession is prevalent among sampled population in Dar es Salaam. However, this problem does not seem to be very severe (the magnitude is generally <3mm). In this study population, gingival recession was significantly associated with age, gender and periodontal conditions (gingival bleeding, dental plaque calculus and periodontal pocket depth). Oral hygiene behaviour/practices (toothbrushing techniques) did not show association with recession of the gum. Recommendation Effort should be made to increase awareness to the population, dental professionals and peer groups on gingival recession. Individuals/communities should be advised to visit dental clinics for check up and treatment if gingival recession is experienced. Improvement should be made in technical know - how to manage the gingival recession, availability of equipments and funding to deal with the gingival recession problem. Government should establish policies that will empower the individuals/communities and dental professionals in the prevention and treatment of gingival recession.