BLOK 11

PENYAKIT JARINGAN PENDUKUNG I

RESUME JOURNAL
PREVALENCE OF PERIODONTAL DISEASE, ITS ASSOCIATION
WITH SYSTEMIC DISEASE AND PREVENTION

KELOMPOK 6
Dosen Tutorial : drg. Audiawati Surrachmin, Sp.PM
Ketua : Delayla Syah Putri 1112019009
Sekretaris : Maurila Firannisa Mahaputri 1112019019
Anggota : Devito Dewantara 1112018009
Anggia Salsabilla 1112019004
Hairunnisa A. Rakib 1112019014
Rafael Ibrahim 1112019024
Rima Andiny Sugiarto Putri 1112019029
Alifa Putri Pardiansyah 1112019034
Waode Ossa Madura 1112019040

FAKULTAS KEDOKTERAN GIGI

UNIVERSITAS YARSI
2019-2020

 KATA PENGANTAR

Alhamdulillah atas segala karunia Allah SWT. Atas ijinnya lah kami bisa
menyelesaikan resume ini dengan tepat waktu dan tak lupa kami kirimkan
shalawat serta salam kepada junjungan Nabi Besar Muhammad SAW. Penulisan
resume bertujuan untuk memenuhi tugas yang telah diberikan oleh dosen tutorial
skenario I. Dalam resume ini, kami menguraikan tentang hal yang berhubungan
dengan tumbuh kembang.
Dalam resume ini, kami mendapatkan bantuan serta bimbingan dari beberapa
pihak. Oleh karena itu, sudah sepantasnya kami ucapkan terima kasih kepada :
1. drg. Audiawati Surrachmin, Sp.PM selaku dosen pembimbing tutorial
2. Orang tua kami yang selalu memberikan support dan dukungan moril
maupun materil
3. Semua pihak yang telah membantu kami dalam menyelesaikan makalah
ini
Akhirul kalam, kami tahu bahwa wrap up ini jauh dari kata sempurna, maka
dari itu kami meminta saran dan kritiknya untuk memperbaiki wrap up ini di masa
mendatang. Harapan kami semoga wrap up ini bisa berguna untuk semua pihak.

ii
 DAFTAR ISI

KATA PENGANTAR ..................................................................................................................... ii
DAFTAR ISI ................................................................................................................................... iii
JURNAL ............................................................................................................................................. 1
TERJEMAHAN JURNAL ........................................................................................................... 11
RESUME JURNAL ....................................................................................................................... 21

iii
 JURNAL

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 Review Article

Prevalence of periodontal disease, its association with

systemic diseases and prevention
Muhammad Ashraf Nazir
Department of Preventive Dental Sciences,
University of Dammam College of Dentistry,
Dammam, Kingdom of Saudi Arabia
Address for correspondence:
Muhammad Ashraf Nazir,
Department of Preventive Dental Sciences,
University of Dammam College of Dentistry,
Dammam, Kingdom of Saudi Arabia.
E-mail: manazir@uod.edu.sa
WEBSITE: ijhs.org.sa
ISSN: 1658-3639
PUBLISHER: Qassim University
ABSTRACT
Periodontal diseases are prevalent both in developed and developing countries and
affect about 20-50% of global population. High prevalence of periodontal disease in
adolescents, adults, and older individuals makes it a public health concern. Several
risk factors such as smoking, poor oral hygiene, diabetes, medication, age, hereditary,
and stress are related to periodontal diseases. Robust evidence shows the association of
periodontal diseases with systemic diseases such as cardiovascular disease, diabetes,
and adverse pregnancy outcomes. Periodontal disease is likely to cause 19% increase
in the risk of cardiovascular disease, and this increase in relative risk reaches to 44%
among individuals aged 65 years and over. Type 2 diabetic individuals with severe form
of periodontal disease have 3.2 times greater mortality risk compared with individuals
with no or mild periodontitis. Periodontal therapy has been shown to improve glycemic
control in type 2 diabetic subjects. Periodontitis is related to maternal infection, preterm
birth, low birth weight, and preeclampsia. Oral disease prevention strategies should be
incorporated in chronic systemic disease preventive initiatives to curtail the burden of
disease in populations. The reduction in the incidence and prevalence of periodontal
disease can reduce its associated systemic diseases and can also minimize their financial
impact on the health-care systems. It is hoped that medical, dental practitioners, and
other health-care professionals will get familiar with perio-systemic link and risk
factors, and need to refer to the specialized dental or periodontal care.
Keywords: Periodontal disease, epidemiology, risk factors, systemic disease,
preventive strategy

Introduction statistics of periodontal diseases vary because of bias, case

Periodontal disease is a chronic inflammatory disease of
periodontium and its advanced form is characterized by
periodontal ligament loss and destruction of surrounding
alveolar bone.1 It is the main cause of tooth loss and is
considered one of the two biggest threats to the oral health.1,2
There are approximately 800 species of bacteria identified in
the oral cavity3 and it is hypothesized that complex interaction
of bacterial infection and host response, modified by behavioral
factors such as smoking, can result in periodontal disease.4
The aim of the review is two-fold: (1) To evaluate the
prevalence of periodontal disease in different populations, risk
factors, and its association with systemic diseases and (2) to
discuss the strategies and measures to prevent and control
periodontal disease.
Prevalence of Periodontal Disease
Periodontal disease is the most common oral condition
of human population. 5 The prevalence and incidence
misclassification, and the number of teeth and the sites
examined.6 According to the Canadian Health Measures Survey
2007-2009, the measurement of loss of periodontal ligament
attachment is considered the gold standard in reporting the
prevalence of periodontal disease. 7 National Health and
Nutrition Examination Survey (NHANES) determined the
attachment loss (AL) and probing depth (PD) at six sites of all
teeth (excluding third molars) for the estimation of periodontal
disease in the U.S.8
The world Health Organization (WHO) has maintained global
oral health data bank using community periodontal index
(CPI).9 This global oral health data from large epidemiological
studies from different countries were gathered to show the
distribution of periodontal disease in adolescents, adults
and elderly populations (Figures 1-3).9 CPI index score
ranges from 0 to 4 and describes the periodontal condition
of individuals at population level. CPI score 0 represents
no periodontal disease; score 1 means gingival bleeding
on probing; score 2 shows the presence of calculus and
bleeding; score 3 indicates shallow periodontal pockets of

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 Nazir: Prevalence of periodondal disease, its associations with systemic diseases and prevention

4-5 mm; score 4 represents deep periodontal pockets of 6
mm or above.9
Compared with developed countries, developing nations have
higher prevalence of calculus and bleeding on probing among
adolescents (Figure 1). The proportion of adolescents with
calculus deposits ranged from 35% to 70% in developing countries
while it ranged from 4% to 34% in developed nations (Figure 1).
Similarly, 14-47% of adult populations in developed countries had
calculus deposits compared with 36-63% of adults in developing
nations. However, developed countries have higher percentage
of individuals with periodontal pockets of 4-5 mm (Figure 2).
Greater proportions of older individuals (65-74 years) exhibit
periodontal pockets of 6 mm or above compared with adult
populations in both developed and developing countries
(Figures 2 and 3).
Overall, periodontal disease affects about 20-50% of the
population around the globe.10
Risk Factors for Periodontal Disease
Several factors increase the risk of periodontal diseases. These
risk factors, modifiable and non-modifiable, contribute toward
the clinical significance of periodontal diseases.

Figure 1: Proportions of adolescents (15-19 years) with and without periodontal conditions using community periodontal index in different
countries9 Pd: Pocket depth

Figure 2: Proportions of adults (35-44 years) with and without periodontal conditions using community periodontal index in different countries9
Pd: Pocket depth

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 Nazir: Prevalence of periodondal disease, its associations with systemic diseases and prevention
Figure 3: Proportions of older adults (65-74 years) with and without periodontal conditions using community periodontal index in different
countries9 Pd: Pocket depth
Modifiable Risk Factors
Smoking
Smoking is one of the most important risk factors for
periodontitis, and the reduction in periodontal disease prevalence
is related to the drop in smoking rates.11 Negative effects of
smoking cigarette, cigar, cannabis, and pipe on periodontal
tissues are similar.12 The smokers are 3 times more likely to
have a severe form of periodontal disease than non-smokers.13
The smokers also present significantly increased the loss of
alveolar bone and higher prevalence of tooth loss compared
with non-smokers, and they have poor outcomes of all forms of
periodontal treatments.10,12,14,15 Evidence suggests that smoking
changes oral microbial flora increases the level of certain
periodontal microorganisms or affects host response.11 The
nicotine has been shown to cause periodontal tissue breakdown,
directly or indirectly through interaction with other factors.16
Poor oral hygiene
Poor oral hygiene is linked with periodontal disease, and lack
of proper tooth brushing and other measures of oral hygiene can
encourage bacterial deposition and build-up of dental plaque on
teeth and gums which can set a stage for inflammatory changes
in periodontal tissues.17 There is pronounced relationship
between poor oral hygiene and increased accumulation of
dental plaque, high prevalence and increased severity of
periodontal disease.18 Axelsson et al. conducted a prospective
study of 15 years duration and found no further deterioration
of periodontal structure among the subjects who maintained
proper oral hygiene and took routine professional dental care.19
Hormonal changes in females
Hormonal changes in women increase the likelihood of
periodontal disease.20 Females may experience gingival
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inflammation before menstruation and during ovulation due to
a high level of progesterone which blocks the repair of collagen
fibers and causes the dilatation of blood vessels.21 Similarly,
pregnant women most frequently exhibit gingival changes,
gingivitis, and sometimes localized growth of gingival tissues.
Fortunately, these inflammatory changes disappear within
few months after delivery without causing persistent damage
to periodontal tissues.22 Estrogen deficiency reduces bone
density after menopause which can culminate in alveolar
bone loss and eventually falling of teeth. A longitudinal study
of 42,171 women at their postmenopausal stages showed that
the treatment of osteoporosis with estrogen hormonal therapy
resulted in reduced tooth loss.23
Diabetes mellitus
Literature consistently shows that diabetes mellitus is one
of the systemic risk factors for periodontal diseases which
can play a major role in initiation and progression of the
disease.24-26 Diabetes mellitus is associated with periodontal
ligament destruction which subsequently can lead to tooth
loss.27,28 Gingival crevicular fluids and saliva have higher
concentrations of inflammatory mediators including different
types of cytokines among diabetic patients with periodontitis
as compared to non-diabetic individuals with periodontal
disease.29 A report of a joint workshop of European Federation
of Periodontology and American Academy of Periodontology
identified dose-response relationship between the severity of
periodontal disease and adverse consequences of diabetes, and
periodontal treatment has been found as beneficial as giving
an antidiabetic medication to the diabetic patients.29
Medications
Vulnerability to infections and periodontal diseases intensifies
when there is diminished salivary flow due to certain
medications.20 The most common medications which can
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 Nazir: Prevalence of periodondal disease, its associations with systemic diseases and prevention
minimize the flow of saliva and produce dryness of mouth
include tricyclic antidepressants, atropine, antihistamine, and
beta blockers.30 Some drugs (phenytoin, cyclosporine, and
nifedipine) can induce the abnormal growth of gingival tissues
which frequently complicates the appropriate removal of dental
plaque underneath the enlarged gingival mass, and thus, can
further aggravate the existing periodontal disease.20
Stress
It is clear from evidence that stress reduces the flow of
salivary secretions which in turn can enhance dental plaque
formation.15 Rai et al. observed a positive association between
stress scores and salivary stress markers (cortisol, salivary
CgA, b-endorphin, and a-amylase), tooth loss, clinical AL
(5-8 mm), and PD of 5-8 mm.31 A meta-analysis of about
300 empirical articles has indicated that stress is related to
immune system and different immunological changes occur
in response to different stressful events.32 The depressed
individuals have been shown to possess a higher concentration
of cortisol in gingival crevicular fluid, and they respond poorly
to periodontal treatment. Academic stress also results in poor
oral hygiene and inflammation of gingiva with increased
concentration of interleukin-1β.15
Non-modifiable Risk Factors
Age
The risk of periodontal disease increases with the advancing
age that is why the high prevalence of periodontal disease
is seen among elderly population.23 Research identified that
age is associated with periodontal disease, and clinical AL
was significantly higher among individuals aged 60-69 years
compared with group of adults 40-50 years.33
Hereditary
Hereditary is one of the factors associated with periodontitis
which makes some people more susceptible to the disease than
the others.24 The complex interplay of genetic factors with
environmental and demographic factors has been hypothesized
to demonstrate wide variations among different racial and
ethnic populations.34
Association of Periodontal Disease with
other Medical Conditions
Cardiovascular disease
Consistent body of evidence explains the relationship between
cardiovascular diseases and periodontal diseases. A systematic
review identified that periodontitis is a risk factor for coronary
heart disease, and the association is independent of other risk
factors such as diabetes, smoking, and socioeconomic status.35
In a meta-analysis of eight prospective and one retrospective
studies, it has been found that periodontal disease is likely to
75
cause a 19% increase in the risk of cardiovascular disease and
this increase in relative risk reaches to 44% among individuals
aged 65 years and over.36 Another systematic review and meta-
analysis of 11 studies (five cohort and six cross-sectional studies)
found that periodontal disease with increased levels of systemic
bacterial markers was associated with coronary heart disease.37
Similarly, a meta-analysis of 29 studies (22 case–control and
cross-sectional studies, and seven cohort studies) reported
pooled odds ratio of 2.35 and pooled relative risk of 1.34 which
suggest that individuals with periodontal disease had greater
risk and higher odds of developing heart disease than those
without periodontal disease.38 Periodontal disease association
with stroke and peripheral artery disease is even stronger than
coronary heart disease (Figure 4).10
Metabolic disease
There are bi-directional relationship and synergism between
diabetes and periodontal disease.39 A prospective cohort study
of 628 subjects (35 years and older) with a follow-up of
11 years identified that type 2 diabetic individuals with severe
periodontal disease had 3.2 times the risk of mortality due to
ischemic heart disease compared to the individuals with no
or mild periodontal disease (Figure 4).40 Likewise, a meta-
analysis concluded that periodontal therapy improves glycemic
control for at least 3 months in type 2 diabetic subjects.41 A
systematic review provided the evidence to support the role
of periodontal disease in the development of type 2 diabetes
and its complications.42
Scientific literature consistently supports a relationship
between periodontitis and insulin resistance. It has been
argued that periodontal disease exacerbates insulin resistance,
a chronic condition implicated in the pathogenesis of metabolic
disease and type 2 diabetes mellitus.43 Lim et al. evaluated
data of 16,720 subjects from a national survey and identified
an association between insulin resistance and periodontitis in
postmenopausal Korean women.44 It has also been suggested
that periodontal intervention can reduce insulin resistance in
diabetic patients.45
Several systematic reviews have proposed an association between
obesity and periodontal disease and it has been identified as a risk
factor for the development of periodontitis.46-48 Recently, obesity
has been shown to increase oxidative stress in periodontal tissues
and cause their destruction.49,50 The prevalence of obesity is
increasing dramatically around the globe51 and its association
with periodontitis calls for the attention of health-care providers
to prevent these public health issues.
Adverse pregnancy outcomes
Periodontitis is related to adverse pregnancy outcomes which
include maternal infection, preterm birth, low birth weight,
preeclampsia, and microbiological and immunological
factors are implicated in the underlying mechanisms.52-55
Low socioeconomic status, smoking, and urinary tract
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 Nazir: Prevalence of periodondal disease, its associations with systemic diseases and prevention
infection are already known to be associated with premature
birth; however, more recently it was found that periodontal
disease is also strongly linked with premature birth incidents
(Figure 4).56
Rheumatoid arthritis (RA)
Periodontal disease is prevalent among RA patients, and
the disease is thought to initiate autoimmune response in
RA (Figure 4).57 It is suggested that both periodontal disease
and RA have similar underlying pathogenic mechanisms.57
The individuals with RA have high prevalence of alveolar
bone destruction and tooth loss which are also sequelae of
periodontal disease.58
Respiratory diseases
The importance of maintaining optimum oral care among
patients with chronic obstructive pulmonary disease
(COPD) has been emphasized due to its association with
periodontitis. Chung et al. used data of 5,878 adults from
a Korean national survey and found significantly higher
prevalence of periodontitis among COPD patients compared
with healthy individuals.59 In a large cohort study, about
22,332 patients with COPD were compared with individuals
without COPD and it was suggested that subjects with COPD
were at increased risk of developing periodontal disease.60
Similarly, a meta-analysis of 14 epidemiological studies
revealed a significant association between periodontal disease
and COPD and periodontal disease was recognized as an
independent risk factor for COPD (Figure 4).61 It has also
been suggested that oral and periodontal microorganisms are
implicated in bacterial pneumonia.62
Chronic kidney disease (CKD)
There is a bidirectional relationship between periodontal
disease and CKD. Fisher and Taylor identified periodontitis
as a risk factor for CKD in an epidemiological study of
11,955 adults in the U.S.63 A systematic review of four
observational and three interventional studies found that
patients with periodontitis are at increased risk of CKD and
periodontal treatment results in positive outcomes in persons
with CKD.64 Ioannidou and Swede observed a dose-response
relationship between periodontal disease and different stages
of CKD, and they found that individuals with CKD were
30-60% more likely to develop moderate periodontitis.65
Later, in another study by Ioannidou et al., it was shown
that Mexican Americans with low kidney functions were
twice more likely to have periodontal disease compared with
subjects with normal kidney functions.66 Similarly, Iwasaki
et al. demonstrated a link between periodontitis and reduced
kidney functions in Japanese older individuals.67 In a recent
prospective cohort study with 14 years of follow-up, Ricardo
et al. found that CKD individuals with periodontitis had 35%
greater risk of mortality compared with CKD patients without
periodontal disease (Figure 4).68
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Cancers
Increased cancer risk because of periodontal disease has
been demonstrated by Michaud and colleagues.69 The risk
of tongue cancer increases 5.23 times with each millimeter
loss of alveolar bone.70 Fitzpatrick and Katz observed that the
relationship between periodontitis and oral, esophageal, gastric,
and pancreatic cancers have been reported more consistently
in literature than with lung and prostate cancers (Figure 4).71
Impairment of cognitive function
Older adults face decline in their cognitive abilities, which affect
their behaviors including oral hygiene habits.72 There is modest
evidence about an association between periodontal disease
and poor cognitive functions as periodontal inflammation
has been shown to affect cognition in elderly populations.73,74
The analysis of data from Third NHANES-III identified high
levels of serum maker of periodontitis (P. gingivalis IgG) in
individuals with impaired cognitive performance.75 Further, a
recent study by Kamer and associates found that clinical AL
can promote amyloid β accumulation in the brain which can
cause cognitive dysfunction.76
Prevention of Periodontal Disease
WHO recommends employing integrated public health
preventive strategies which should be based on common risk
factor approach. Risk factors such as smoking, stress, and low
socioeconomic status are associated with periodontal disease as
well as other systemic chronic diseases; therefore, inclusion of
oral disease prevention strategies in chronic systemic disease
preventive initiatives can curtail the burden of disease at the
level of population.77
Oral hygiene practices
Proper mouth cleaning, regular tooth brushing, and dental
flossing are most effective in preventing oral disease and
periodontitis. Despite utmost significance of tooth brushing,
about half of the population brush twice a day.78 There are
various sizes, shapes, and types of toothbrushes; however, two
more common types include powered toothbrushes and manual
toothbrushes. Powered toothbrushes offer more advantage over
the manual toothbrushes in reducing dental plaque.79
Diet
Although the role of diet in the prevention of dental caries is
more significant compared with preventing periodontal disease;
nonetheless, poor diet can negatively affect periodontal tissues
causing rapid progression of disease.80 The vitamin C deficiency
as a risk factor for periodontal disease has been discussed in
the literature. Nishida et al. used a sample of 12,419 adults and
showed that there was increased risk of periodontal disease due
to the poor dietary intake of vitamin C, and also observed a
dose-response relationship between vitamin C and the severity
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 Nazir: Prevalence of periodondal disease, its associations with systemic diseases and prevention
Figure 4: Association between periodontal disease and various systemic conditions
of periodontal disease.81 A diet high in fruits, vegetables and
low in fat and sugars is required for the healthy periodontal
tissues. Vitamins C and E have antioxidant properties which
help to reduce the production of reactive oxygen radicals formed
during the inflammatory process.80 Low-calorie intake has been
shown to reduce inflammatory changes and diminish the tissue
damage in periodontal disease.82
Use of fluoride
Stannous fluoride has antiplaque and antigingivitis effects
and it reduces the proportion of bacteria and spirochetes
in subgingival areas, thus can help to promote gingival
health. 83,84 He et al. conducted a randomized double-
blinded trial to investigate the antimicrobial role of stannous
fluoride dentifrice in periodontal disease and found a
significant reduction in gingival bleeding over a period of
2-month.85
Use of antimicrobial agents
Chlorhexidine, triclosan, essential oils and zinc in
toothpastes, mouthwashes and gels are used to control
specific periodontal bacteria as well as plaque. 86,87
Chlorhexidine reduces dental plaque (55% reduction in
dental plaque) and gingival inflammation (30-45% decrease
in gingivitis) by lowering inflammatory mediators. 88
Gunsolley compared the effectiveness of antiplaque and
antigingivitis mouthrinses with oral hygiene instructions
and adult prophylaxis and found great improvement in oral
hygiene due to antiplaque and antigingivitis mouth rinses.89
Moreover, research data from several clinical trials support
that antimicrobial mouth rinses have equal or greater efficacy
77
in controlling gingival disease than the use of interproximal
dental floss.90-92
Smoking cessation
Since smoking is a major risk factor for periodontal disease,
therefore smoking cessation can prevent a considerable
proportion of periodontitis cases.93 Smoking cessation not only
inhibits further progression of periodontal disease but can also
reduce the periodontal tissue destruction.94
Community and high risk approaches
Breast cancer and cervical cancer screening are considered
successful examples of screening for the prevention of
diseases, but the decision of oral screening should be based
on careful evaluation of financial burden, ethical aspects, and
efficacy and adverse effects of the intervention.95 In addition,
implementation of oral health promotion policies at local,
national and international levels can help bring sustainable
reduction in periodontal disease burden and improve the
quality of life of people. Scaling is considered the most
common professional preventive measure for periodontal
disease. Because of the association between periodontal
disease and cardiovascular disease, scaling has recently been
shown to reduce the incidence of acute myocardial infarction
and stroke.96
Conclusion and Recommendations
• Although periodontal disease is the most prevalent
infectious oral condition but is treatable and preventable.
• The reduction in the incidence and prevalence of
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 Nazir: Prevalence of periodondal disease, its associations with systemic diseases and prevention
periodontal disease can result in lowering its associated
systemic diseases and complications.
• Decreased periodontal disease burden can minimize
treatment needs and can reduce financial impact on health-
care systems.
• High prevalence of periodontal disease also necessitates
the establishment of surveillance system for oral diseases
in the community.
• Preventive programs for periodontal disease should utilize
common risk approaches to reduce the magnitude of other
chronic diseases.
• Cost-effective strategies would also enhance
interdisciplinary collaborations among health-care
providers.
• Health-care providers should be familiar with perio-
systemic link and should be able to diagnose and refer
the patients to specialized dental or periodontal care to
improve the quality of life of their patients.
Further research is needed to explore the underlying
mechanisms and risk factors of periodontal disease and develop
innovative preventive strategies.
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14
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a]R UZ SRhRY RddR XZ_XZgR jR_X V SVdRc UR_ RcV_R_jR SZdR aV_R_UR SR eVcZ UZ RZe R_ UV_XR_ aV_jR Ze [R_ef_X c _Vc% .

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15
 BRkZc1 DcVgR]V_dZ aV_jR Ze aVcZ U _UR] YfSf_XR__jR UV_XR_ aV_jR Ze dZdeV Z UR_ aV_TVXRYR__jR

Z_WV dZ dfURY UZ VeRYfZ eVc RZe UV_XR_ V]RYZcR_ acV Refc2 _R f_ FC I

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 RESUME JURNAL

Judul : Prevalence of periodontal disease, its association with systemic

disease and prevention
Peneliti : Nazhir, MA
Sumber : International Journal of Health Science. Prevalence of
Periodontal Disease, its Association with Systemic Disease and Prevention.
Dammam, Kingdom of Saudi Arabia: Qassim University; 2017
Tujuan : Untuk mengevaluasi prevalensi penyakit periodontal
(populasi, factor risiko, hubungan dengan penyakit sistemik) dan untuk
mendiskusikan strategi dan tindakan untuk mencegah penyakit periodontal.
Pendahuluan
Penyakit periodontal adalah penyakit peradangan periodonsium kronis dan bentuk
lanjutnya ditandai dengan hilangnya ligamen periodontal dan kerusakan tulang
alveolar di sekitarnya. 1 Ini adalah penyebab utama kehilangan gigi dan dianggap
sebagai salah satu dari dua ancaman terbesar bagi kesehatan mulut.

Tujuan dari tinjauan ini ada dua: (1) Untuk mengevaluasi prevalensi penyakit
periodontal pada populasi yang berbeda, faktor risiko, dan hubungannya dengan
penyakit sistemik dan (2) untuk mendiskusikan strategi dan tindakan untuk
mencegah dan mengendalikan penyakit periodontal.

Prevalensi penyakit periodontal

Organisasi Kesehatan Dunia (WHO) telah memelihara bank data kesehatan mulut
global menggunakan indeks periodontal komunitas (CPI). Data kesehatan mulut
dikumpulkan untuk menunjukkan distribusi penyakit periodontal pada remaja,
dewasa dan populasi lanjut usia. 9 Skor indeks CPI berkisar dari 0 sampai 4 dan
menggambarkan kondisi periodontal individu pada tingkat populasi. Skor CPI 0
menunjukkan tidak ada penyakit periodontal; skor 1 berarti perdarahan gingiva
saat probing; skor 2 menunjukkan adanya kalkulus dan perdarahan; skor 3
menunjukkan kantong periodontal dangkal 4-5 mm; skor 4 menunjukkan poket
periodontal dalam 6 mm atau lebih tinggi.

Negara maju memiliki fasilitas kesehatan yang lebih maju sehingga

kesehatan gigi di Negara maju lebih baik dibandingkan Negara berkembang.
Kemudian individu yang lebih tua (64-70 tahun) proporsinya lebih besar

21
menunjukkan poket periodontal. Secara keseluruhan, penyakit periodontal
mempengaruhi sekitar 20-50% pasien populasi di seluruh dunia.

Faktor risiko penyakit periodontal

A. Faktor risiko yang dapat diubah
1. Merokok
Penurunan prevalensi penyakit periodontal terkait dengan penurunan
tingkat merokok. Perokok lebih sering terjadinya kehilangan tulang
alveolar dan prevalensi kehilangan gigi yang lebih tinggi dibandingkan
non-perokok. Merokok dapat mengubah mikroba pada mulut
mempengaruhi respon host sehingga dapat menyebabkan penyakit
periodontal.

2. Kebersihan mulut yang buruk

Kurangnya menyikat gigi dengan benar dapat mengakibatkan
pengendapan bakteri dan penumpukan plak gigi dan menyebabkan
perubahan inflamasi pada jaringan periodontal, maka prevalensi akan
tinggi dan peningkatkan keparahan penyakit periodontal.

3. Perubahan hormonal pada wanita

Umumnya terjadi pada wanita sebelum menstruasi dan selama proses
ovulasi karena tingginya progesteron. Wanita hamil juga sering
menunjukan perubahan gingiva, gingivitis. Ada kekurangan pada estrogen
yaitu mengurangi kepadatan tulang setelah menopause yang dapat
menyebabkan kehilangan tulang alveolar dan gigi lepas.

4. Diabetes mellitus
Salah satu factor risiko sistemik yang dapat berperan besar dalam inisiasi
dan perkembangan penyakit. DM berhubungan dengan kerusakan
ligament periodontal yang dapat menyebabkan kehilangan gigi. Cairan
sulkus gingiva dan saliva memiliki konsentrasi mediator inflamasi yang
lebih tinggi (sitokin).

5. Pengobatan

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 Infeksi dan penyakit periodontal dapat meningkat saat aliran saliva
berkurang karena obat-obatan. Obat yang meminimalkan aliran saliva
yaitu antidepresan trisiklik, atropine, antihistamin. Beberapa obat
(fenitoin, siklosporin dan nifedipine) dapat menyebabkan pertumbuhan
abnormal jaringan gingiva yang sering mempersulit pencabutan gigi dan
semakin meningkatkan penyakit periodontal yang ada.

6. Stress
Stress dapat mengurangi aliran sekresi saliva dan dapat meningkatkan
pembentukan plak gigi. Jika mengalami depresi dapat menyebabkan
konsentrasi kortisol yang lebih tinggi dalam cairan sulkus gingiva.

B. Faktor risiko yang tidak dapat diubah

1. Usia
Prevalensi penyakit periodontal yang tinggi terlihat pada populasi lansia.
AL (attachment loss) secara signifikan lebih tinggi pada i individu yang
berusia antara 60-69 tahun dibandingkan dengan kelompok usia 40-50
tahun.

2. Turun – temurun
Berhubungan dengan faktor genetik, faktor lingkungan, dan juga faktor
etnis (ras, suku, dan kebiasaan) diduga menjadi salah satu faktor utama
periodontitis. Salah satu contohnya adalah ras dan kebiasaan orang – orang
tertentu yang terjadi secara turun – temurun.

Asosiasi penyakit periodontal dengan kondisi medis lainnya

1. Penyakit kardiovaskular
Periodontitis merupakan faktor risiko penyakit jantung koroner, dan
hubungannya tidak tergantung pada faktor risiko lain. Hubungan penyakit
periodontal dengan stroke dan penyakit arteri perifer bahkan lebih kuat
daripada penyakit jantung koroner.

2. Penyakit metabolik
Ada hubungan dua arah dan sinergisme antara diabetes dan penyakit
periodontal. terapi periodontal meningkatkan kontrol glikemik setidaknya
selama 3 bulan pada subjek diabetes tipe 2. Baru-baru ini, obesitas telah
terbukti meningkatkan stres oksidatif pada jaringan periodontal dan

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 menyebabkan kerusakannya. Prevalensi obesitas meningkat secara dramatis di
seluruh dunia.

3. Hasil kehamilan yang merugikan

Periodontitis terkait dengan hasil kehamilan yang merugikan yang meliputi
infeksi ibu, kelahiran prematur, berat lahir rendah, preeklamsia, dan faktor
mikrobiologis dan imunologi. baru-baru ini ditemukan bahwa penyakit
periodontal juga sangat terkait dengan insiden kelahiran prematur.

4. Reumatoid Artritis (RA)

Individu dengan RA memiliki prevalensi tinggi kerusakan tulang alveolar dan
kehilangan gigi yang juga merupakan gejala sisa dari penyakit periodontal.

5. Penyakit pernapasan
Pentingnya mempertahankan perawatan mulut yang optimal di antara pasien
dengan penyakit paru obstruktif kronik (PPOK) telah ditekankan karena
hubungannya dengan periodontitis. pasien dengan penyakit paru obstruktif
kronik dibandingkan dengan individu tanpa penyakit paru obstruktif kronik
dan disarankan bahwa subjek dengan penyakit paru obstruktif kronik berisiko
lebih tinggi terkena penyakit periodontal.

6. Penyakit ginjal kronis

Ada hubungan dua arah antara penyakit periodontal dan penyakit ginjal
kronis. studi intervensi menemukan bahwa pasien dengan periodontitis berada
pada peningkatan risiko penyakit ginjal kronis dan perawatan periodontal
menghasilkan hasil yang positif pada orang dengan penyakit ginjal kronis.
menemukan bahwa individu penyakit ginjal kronisdengan periodontitis
memiliki risiko kematian 35% lebih besar dibandingkan dengan pasien
pnyakit ginjal kronis tanpa penyakit periodontal.

7. Kanker
Peningkatan risiko kanker karena penyakit periodontal dibuktikan oleh
Michaud dan rekannya. Hubungan antara periodontitis dan kanker mulut,
esofagus, lambung, dan pankreas telah dilaporkan lebih konsisten dalam
literatur dibandingkan dengan kanker paru-paru dan prostat.

8. Penurunan fungsi kognitif

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 Orang dewasa yang lebih tua menghadapi penurunan kemampuan kognitif
mereka, yang memengaruhi perilaku mereka termasuk kebiasaan kebersihan
mulut. Bahwa attachment loss klinis dapat meningkatkan akumulasi amiloid β
di otak yang dapat menyebabkan disfungsi kognitif.

Pencegahan penyakit periodontal

1. Praktik kebersihan mulut
Pembersihan mulut yang benar, menyikat gigi secara teratur, dan flossing gigi
paling efektif dalam mencegah penyakit mulut dan periodontitis. Meskipun
menyikat gigi sangat penting, sekitar setengah dari populasi menyikat gigi dua
kali sehari

2. Diet
Pola makan yang buruk dapat berdampak negatif pada jaringan periodontal
yang menyebabkan perkembangan penyakit yang cepat. Diet tinggi buah-
buahan, sayuran, rendah lemak dan gula diperlukan untuk jaringan periodontal
yang sehat. Asupan kalori rendah telah terbukti mengurangi perubahan
inflamasi dan mengurangi kerusakan jaringan pada penyakit periodontal.

3. Penggunaan fluoride
Stannous fluoride memiliki efek antiplaque dan antigingivitis dan mengurangi
proporsi bakteri dan spirochetes di daerah subgingiva, sehingga dapat
membantu meningkatkan kesehatan gingiva.

4. Penggunaan agen antimikroba

Klorheksidin, triclosan, minyak esensial dan seng dalam pasta gigi, obat
kumur dan gel digunakan untuk mengendalikan bakteri periodontal tertentu
serta plak. Klorheksidin mengurangi plak gigi (55% penurunan plak gigi) dan
inflamasi gingiva (30-45% penurunan gingivitis) dengan menurunkan
mediator inflamasi.

5. Penghentian merokok
Penghentian merokok dapat mencegah sebagian besar kasus periodontitis.
Penghentian merokok tidak hanya menghambat perkembangan lebih lanjut
dari penyakit periodontal tetapi juga dapat mengurangi kerusakan jaringan
periodontal.

6. Pendekatan komunitas dan risiko tinggi

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 Scaling dianggap sebagai tindakan pencegahan professional yang paling
umum untuk penyakit periodontal. Karena hubungan antara penyakit
periodontal dan penyakit kardiovaskuler, scaling baru-baru ini telah terbukti
mengurangi kejadian infark miokard akut dan stroke.

Kesimpulan
Penyakit periodontal adalah kondisi infeksi mulut yang sering terjadi di kalangan
usia muda sampai tua, namun penyakit periodontal dapat diobati dan dicegah
dengan cara menjaga kebersihan mulut, mengatur pola makan, penggunaan
fluoride, penggunaan agen antimikroba, penghentian merokok, dan pencegahan
risiko yang tinggi.
Insiden dan prevalensi penyakit periodontal dapat menurunkan penyakit
sistemik dan komplikasi yang terkait. Penyakit periodontal yang menurun dapat
meminimalkan kebutuhan perawatan dan mengurangi dampak ekonomi pada
sistem perawatan kesehatan. Jika prevalensi penyakit periodontal tinggi juga
dibutuhkan sistem surveilans atau mensurvei perkembangan penyakit mulut di
masyarakat.
Program pencegahan untuk penyakit periodontal harus dihubungkan
dengan risiko umum untuk mengurangi terjadinya penyakit kronis lainnya.
Penyediaan layanan kesehatan harus terbiasa dengan hubungan perio-sistemik,
mampu mendiagnosis, dan merujuk pasien ke perawatan gigi atau periodontal
khusus untuk meningkatkan kualitas hidup pasien.
Penelitian disarankan untuk mengeksplorasi mekanisme dan faktor risiko penyakit
periodontal serta mengembangkan strategi pencegahan yang inovatif.

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