Periodontal diseases in tanzania.

Abstract

The aim of this thesis was to study the epidemiology, susceptibility and prevention programmes with regard to periodontal diseases in Tanzania. Economic constraints to a large extent restrict the availability of both facilities and professional manpower. The level of periodontal disease destruction had been reported to be limited, although calculus and bleeding were frequently found. In an attempt to confirm the previous descriptions of the prevalence and severity of periodontal diseases in Tanzania, and to identify subjects for the study on susceptibility, a descriptive study was undertaken. 553 subjects from urban and rural Morogoro were examined for width of attached gingiva, calculus, gingival recession, gingival bleeding and probing pocket depth. In conformity to the previous studies, the results showed abundance of calculus and gingival bleeding. In spite of the poor oral hygiene, the destructive phases of periodontal diseases were not frequently present and these seem to be a problem for only a part of the population, mostly at older age. The large variations between and within individuals that were seen, prompted the desirability of early identification of particularly susceptible subfractions of the population. In this context, clinical and microbiological examinations were performed. Bleeding/plaque ratio

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--- -- -,~ 11 its association with periodontal destruction, as well as its potential to identify subjects with periodontal destruction, were studied in 26 subjects who exhibited at least three teeth with pocket depth of ~5 mm (cases) and 28 subjects exhibiting no pockets deeper than 3 mm (controls). The cases had significantly higher gingival bleeding scores than the controls, but comparable plaque scores. The use of an extended scale of bleeding (0-2 points) was more discriminative between cases and controls than a compressed scale of bleeding (0-1 points). Microscopic examination of spirochetes in plaque samples from pockets showed higher percentages of spirochetes than from non destructive sites, which corroborates with earlier findings. At non destructive sites, a significant higher percentage of spirochetes was found in cases than in controls, indicating a so far not described host effect. Despite the significant difference in percentage of spirochetes between cases and controls, spirochete counts did not provide a reliable measure to identify subjects with destructive diseases. The impact of oral health education and the removal of calculus in the prevention / management of periodontal diseases were investigated in three groups (intensive oral health education, less intensive oral health education and control) of students over a period of 23 months. No effects of oral health education (OHE) in reducing bleeding and retarding calculus growth were -~--

III demonstrated at a level of clinical significance. The scaling effects on bleeding were small and of no clinical significance, whereas the overall clinical effects of scaling were very limited in this study. It is concluded that the periodontal conditions are within the range previously reported for Tanzania and other East African countries. Individuals with destructive periodontal diseases could be identified on the basis of their bleeding score at the gingival margin and with the use of the modified bleeding/plaque ratio. Furthermore, the study challenges the essence of carrying out large scale oral health education programmes and scaling in the existing cultural, social and economical situation in Tanzania.