Periodontal status, treatment needs and awareness of periodontal diseases among adult cardiac patients attending Muhimbili National Hospital, Dar es Salaam, Tanzania.

Abstract

Background The periodontal diseases (PDs) have recently been reported to be associated with cardiovascular diseases (CVDs). In Tanzania there is no available information on the matter. In Tanzania, the most common cardiovascular diseases includes: hypertension, cardiomyopathy, stroke, angina pectoris valvular heart diseases, rheumatic heart disease, congestive cardiac failure, ischemic heart disease. Objective The aim of this study was to determine the periodontal status, treatment needs and awareness of periodontal diseases among adult cardiac patients attending the Muhimbili National Hospital, Dar-es-salaam Tanzania. Methodology This was a hospital based descriptive cross-sectional study conducted between July and December 2013. No sampling was done. All consented patients were included in the study. The study participant‘s socio-demographic factors were gathered through self administered structured questionnaires in the cardiac unit, followed by clinical examination carried out by single examiner in the dental building for assessing the presence of plaque, calculus, gingival bleeding on gentle probing, periodontal pocket depth in (mm), gingival recession in (mm) and periodontal attachment loss in (mm). Also tooth mobility and missing teeth were assessed accordingly. A sample of 340 cardiac patients, 116 male and 224 female subjects aged 18 years and above who attended the Muhimbili Cardiac clinic during the study period was enrolled in the study. All information obtained were coded, entered in a computer and analyzed using SPSS version 16.0. Frequencies and percentages were chosen to show the distribution of periodontal diseases in adult cardiac patients. Chi-square test was used to compare proportions between sex and age group studied. The t- test was used for comparing the mean number of sextants examined according to the age groups and sex respectively, and the level of statistical significance was set at p < 0.05. Results Of the 340 study participants, 224 (65.9%) were female providing a male to female ratio of about 1:2. It was observed that, majority of the males (75.9%) and females (74.6%) participants were not aware of the gum diseases and their differences were not statistically significant. Majority of the patients presented with plaque, calculus and gingival bleeding on gentle probing in one or more of the teeth surfaces examined. The prevalence of gingival bleeding on gentle probing was 79.3% among all cardiac patients studied, among males (84.8%), among female (73.5%) with mean number of sites with gingival bleeding 11.11 ± 6.27. The prevalence of dental plaque was 91.8% among all cardiac patients studied, among males (97.3%) and among females (95.6%) with mean number of sites with plaque12.28 ± 6.84. The prevalence of dental calculus was 96.5% among all cardiac patients studied, among males (98%), among females (95.8%) with mean number of sites with calculus 15.0 ± 6.42. The prevalence of mobile teeth was 17% among all cardiac patients studied with mean number of mobile teeth 0.5 ± 1.58. Majority with mobility grade II. The prevalence of missing teeth was 90.9% among all cardiac patients studied. The mean number of missing teeth was 3.47 ± 3.48 among males and 3.15 ± 3.06 among females. There was statistical significance difference in mean number of missing teeth between the age groups. Majority of tooth loss was due to dental caries 91.4% followed by periodontal diseases 7.3% and the least was due to trauma (1.3%). The prevalence of periodontal pockets greater than 3.5 mm was 9.4% among all cardiac patients studied. Periodontal pockets were more common in the age groups 45-64 and 65+ years. There was significant difference in mean sites with periodontal pockets less than 3.5mm between age groups. The prevalence of gingival recession was 20.5% among all cardiac patients studied with mean 5.39 ± 14.63 with no significant difference in the mean number between males and females as well as between age groups. The prevalence of periodontal attachment loss was 20.3% among all cardiac patients studied with mean 5.69 ± 15. There was no difference in mean number of sites with periodontal attachment loss between males and females as well as between age groups. Practically every participant needed oral hygiene instructions and professional scaling and root planning (TN-1 and TN-2). Scaling and root planing (TN-2) was needed to all participants. Complex periodontal treatment needs required to about 0.9% all over 45 years old for the patients with periodontal pockets greater than 5.5 mm. Conclusion This study has shown that majority of the patients were not aware of the gum diseases. Majority of the patients presented with plaque, calculus and gingival bleeding on gentle probing in the teeth surfaces examined. Teeth mobility was observed in few subjects examined of which majority of the examined teeth had grade two mobility. Periodontal diseases accounted the second cause of teeth loss. Periodontal pockets were more prevalent in the age groups of forty five years and above. About one fifth of the studied population had gingival recession and the prevalence increased with age. The periodontal treatment needs for the study population include mainly oral hygiene instructions followed by professional scaling and root planning. The need for complex periodontal therapy was limited to a smaller proportion of the study population. Recommendations 1. More effort is needed to provide oral health information (education) to general public. This can be done to: - Individuals (attendance to dental clinics for check up and treatment) - Cardiac patients at clinics to reinforce effective tooth brushes for needy patients - Medical personnel to include some dental contents in medical, nursing curricular to increase the awareness. - Communities through media (radio and television programs). 2. Oral health promotion is to be instituted to improve oral hygiene so as to prevent gingivitis and periodontal diseases to the general population.