Determinants of self-reported periodontal health in South Africa : results from a national survey

Abstract

Background: Since self-reported periodontal or ‘gum’ health may be explained by the same factors that are associated with clinical periodontal health status, it has been suggested as a useful measure for service planning and for monitoring periodontal health in developing and resource-limited countries, where logistics and the costs of clinical oral surveys may be major barriers to risk factor surveillance. Objectives: To determine the systemic health and lifestyle factors associated with self-reported poor periodontal health status in South Africa. Data source: The second South African Demographic and Health Survey (SADHS) done in 2003. Methods: This secondary data analysis focused on data on dentate adults aged ≥15 years who participated in the 2003 SADHS (n=6,319). Information obtained included socio-demographic data, health risk behaviours (tobacco and alcohol use) and chronic diseases. Nutrient intake was computed based on food frequency items contained in a Nutrient Index (N-Index) developed for use in South Africa. Taking into account the complex sample design used in the SADHS, data analysis included the use of t-test, Chi-square and multiple logistic regression analysis. The level of significance was set at p<0.05. Results: Of the respondents, 4.6% (95% CI = 3.9 - 5.5) self-reported having had a ‘gum problem’ or poor periodontal health in the 6 months prior to the survey date. In the general dentate population, those who reported poor periodontal health were older than those who did not report poor periodontal health at a significant level (36.2% vs. 38.8%; p = 0.02); and they were more likely to be problem drinkers (2.53; 95% CI = 1.68 – 3.82), as compared to non-drinkers. Having suffered a stroke (4.13; 95% CI = 1.53 – 11.11) or suffering from arthritis (1.70; 95% CI = 1.00 = 2.90) were significant associated with higher odds of reporting poor periodontal health. Black South Africans have higher odds of reporting poor periodontal health (3.91; 95% CI = 1.38 – 11.05) than white South Africans. On further stratifying the study participants into younger (≤45 years) and older (>45 years) adults, factors associated with poor periodontal health were found to be different. In particular, reporting making yearly preventive dental care visits was significantly associated with reporting poor periodontal health only among younger adults (OR = 0.40; 95%CI = 0.18 – 0.90), while the racial gradient in reporting poor periodontal health remained significant only for older adults. Conclusion: The study’s findings highlight the need to integrate oral health promotion with general health promotion programmes, especially those targeted at chronic disease prevention and rehabilitation.