The prevalence of dental diseases and medical and social characteristics in young people

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BACKGROUND

According to the World Health Organization (WHO), dental caries and periodontal diseases are the most common pathologies among oral diseases worldwide [1–3]. Despite ongoing treatment and preventive programs, the prevalence of dental diseases remains high, which is important in young people (aged 18–44 years according to the WHO) [4, 5].

In the Russian Federation, in people aged <30 years, inflammatory periodontal diseases rank second after dental caries, and in people aged >30 years, they rank first, approaching 90% [6].

According to WHO objectives, by 2020, people aged 18 years should not have any extracted teeth, and by 2030, dental caries in children should be eliminated [7, 8], which is obviously unattainable in the Russian Federation because of the non-tendency toward reducing the prevalence of caries [9].

The prevalence of oral diseases is influenced by many socioeconomic factors (education, occupation, financial situation, etc.), as well as age, sex, place of residence, fluoride intake, individual oral care, diet, general somatic diseases, etc. [10, 11].

Thus, identifying the factors that determine the prevalence of oral diseases among young people is a pressing issue in dentistry.

This study aimed to analyze the medical and social characteristics of young people and their effect on the prevalence of dental diseases.

METHODS

Study design

An observational single-center study was conducted.

Compliance criteria

The study enrolled 917 respondents, including 592 women and 325 men.

Inclusion criteria: Patients of both sexes, aged 18–44 years, who sought treatment or preventive examination and did not receive previous dental treatment for at least 6 months.

Non-inclusion criteria: Individuals aged <18 years and >45 years, presence of acute inflammatory diseases, exacerbation of chronic general somatic pathologies, somatic diseases in the decompensation stage, oncological diseases, and refusal to participate in the study.

Conditions

The study was conducted at the Clinical Diagnostic Center for Therapeutic Dentistry of the N.I. Pirogov Russian National Research Medical University. The clinical examination included a comprehensive assessment of the oral cavity condition and determination of the medical and social characteristics of young people. All participants gave voluntary informed consent to participate in the study.

Study duration

The study was conducted in 2018–2023.

Description of the medical intervention

A clinical examination protocol and a questionnaire for the respondents were developed. The condition of the bone and periapical tissues was assessed using X-ray data (orthopantomogram). The characteristics of dental and somatic morbidity were performed in accordance with the International Classification of Diseases Tenth revision. Clinical examination included the determination of the number of carious (C), filled (F), and extracted (E) teeth (CFE), Silness–LÖe, and Green–Vermillion indexes, papillary–marginal–alveolar (PMA) index, and community periodontal index of treatment needs and identification of non-carious lesions of teeth, bite pathology, and diseases of the pulp, periapical tissues, and periodontium. To establish the influence of social and hygienic factors on the condition of the oral cavity, the results of the survey were analyzed.

Subgroup analysis

To reveal factors influencing the maintenance of oral health, two groups were identified: group 1 included 150 young patients with oral diseases (64 men, 86 women) by random sampling, and group 2 (comparison) consisted of 54 patients with good oral hygiene (15 men, 39 women).

Ethical examination

The study was approved by the local ethics committee of the N.I. Pirogov Russian National Research Medical University (Protocol No. 215 of February 21, 2024).

Statistical analysis

Statistical data analysis was performed using Microsoft Office Excel (Microsoft Corporation, VA, USA) and Statistica 6.0 (Stat Soft Inc., USA). Relative values were calculated, and descriptive statistics were used to determine the arithmetic mean, average error, and mean-square deviation, as well as nonparametric analysis methods. The sample size was not previously calculated. P-values of <0.05 indicated significance.

RESULTS

Study participants

At the time of examination, all respondents lived in Moscow or in a region in Moscow. The study involved 917 respondents, including 592 women (mean age, 31.0±2.4 years) and 325 men (mean age, 34.0±2.1 years).

In this study, 61.3% of the respondents examined lived in Moscow or in a region in Moscow until 18 years of age, and the remaining 38.7% lived in other regions of the Russian Federation (Kirov, Samara, Smolensk, Tula, Tver, Kostroma, Lipetsk, Astrakhan, Rostov, Ryazan, Vladimir, Volgograd, Voronezh, Belgorod, Oryol, Tyumen, Novosibirsk regions, Republic of Buryatia, Mordovia, Tyva, Tatarstan, and the republics of the North Caucasus) or Commonwealth of Independent States. Moreover, 18.4% of the respondents were students during the survey period, 76.6% were employed, and 5.0% were unemployed.

Main research results

Despite the availability of dental care in state medical institutions in Moscow and its regions under the compulsory medical insurance system, 91.2% expressed a preference for commercial medical organizations. Moreover, 49.7% of the respondents noted the financial accessibility of treatment in commercial clinics.

Dental caries was detected in 94.2% of the respondents, pulp and periapical tissue diseases in 47.4%, gingivitis in 52.9%, and periodontitis in 33.9% (Table 1).

 

Table 1. Characteristics of the surveyed patients by sex parameters and prevalence of oral diseases

Oral diseases	Respondents
	Total (n=917)	Men (n=325)	Women (n=592)
Dental caries	864	310	554
Non-carious lesions of teeth	78	17	61
Diseases of the pulp and periapical tissues	435	174	261
Endemic mottling (fluorosis) of teeth	83	11	72
Dental hyperesthesia	101	23	78
Increased tooth wear	37	15	22
Malocclusions	413	199	214
Gingivitis	486	185	301
Periodontitis	312	113	199
No diseases (oral sanitation)	54	15	39

 

In the examination of the soft tissues of the oral cavity, 6.8% of the respondents had pathologies of the cords/frenulum of the lips. In addition, the mixed periodontal biotype predominated (5.3%). Gum recession was detected in 10.2%, and pathological mobility of a tooth (or several teeth) was found in 5.9% of the respondents.

In this study, 37.3% of the respondents in group 1 (n=150) lived in Moscow or in one of its regions and were <18 years of age. In group 2 (n=54), this figure was 80.6%. The results showed a significant social difference between patients with oral diseases and healthy ones.

The CFE index in group 1 exceeded that in group 2, mainly due to the “C” (3.7±0.8 in group 1 and 0 in group 2; p <0.05) and “E” (1.6±0.4 and 0.9±0.2 in groups 1 and 2, respectively; p <0.05) components (Table 2).

 

Table 2. The results of a comparative analysis of the index assessment of the oral cavity in young people (M±sd)

Index	Group 1	Group 2
CFE	13.2±1.9 (C — 3.7±0.8; F — 7.9±0.6; E — 1.6±0.4)	8.7±0.6 (C — 0; F — 7.8±0.3; E — 0.9±0.2)
Silness–LÖe	2.20±0.41	0.50±0.34
Green–Vermillion	1.50±0.35	0.70±0.19
РМА, %	32.6±4.1	0.05±0.01
CPITN	2.70±0.53	0.500±0.067

Note. The probability of an error-free forecast is p <0.05.

 

The results of the clinical examination showed marked differences in the indexes measured in the oral cavity of the study groups. Individual oral hygiene was satisfactory in group 1 and good in group 2. In group 1, inflammation was noted in the soft periodontal tissues, and the majority of the respondents required professional oral hygiene and elimination of factors that contribute to plaque retention.

Regarding the regularity of examinations, 7.2% of the respondents in group 1 and 18.1% in group 2 visit the dentist once every 6 months, which is necessary for oral disease prevention. Most respondents in group 1 visit the dentist once every few years (53.8%), whereas a slightly higher number (57.3%) of respondents in group 2 visit the dentist once a year (Table 3).

 

Table 3. Regularity of visits to the dentist among the examined (%)

Regularity of visits	Group 1	Group 2
Once every 6 months or more often	7.2	18.1
Once a year	17.6	57.3
Once every few years	53.8	17.2
Only in case of complaints	21.4	7.4
Total	100	100

Note. The probability of an error-free forecast is p <0.05.

 

In the analysis of the questionnaire and medical history, the nature and prevalence of complaints among respondents were established (Table 4). The absence of any complaints on the oral cavity was noted by 22.4% and 73.9% of young people in groups 1 and 2, respectively (p <0.05). Moreover, 27.5% and 7.4% of the respondents in groups 1 and 2 had more than one oral complaint. In group 1, the most common complaints were pain in the hard tissues of the teeth in response to irritants (temperature and chemical) and bleeding gums, and in group 2, complaints were unsatisfactory dental esthetics, chips/defects of restorations (fillings, artificial crowns, and veneers), malocclusions, gum recession and food entrapment, and temporomandibular joint (TMJ) disorders presented by 8.1% of the respondents.

 

Table 4. Nature and prevalence of complaints (per 100 surveyed) (%)

Nature of complaints	Group 1	Group 2
No complaints	22.4	73.9
Bleeding gums	18.6	3.2
Soreness of hard dental tissues from temperature and chemical irritants	36.2	6.5
Tooth pain when chewing/biting	10.2	2.1
Increased tooth sensitivity	9.6	6.2
Gum pain	9.1	1.3
Tooth mobility	5.3	0
Fetid breath	8.9	4.2
Missing tooth (teeth)	7.3	2.1
Other complaints, including esthetics, chips/defects of restorations, fillings, malocclusions, gingival regression, food impaction, TMJ complaints, etc.	15.7	8.1

Note. TMJ — temporomandibular joint; the probability of an error-free forecast is p <0.05.

 

Considering the need for regular removal of dental plaque to prevent periodontal diseases and hard dental tissues, items about professional oral hygiene were included in the questionnaire. Specifically, 6.5% and 16.7% of the respondents in groups 1 and 2, respectively, underwent professional hygiene at the dentist once every 6 months (Table 5).

 

Table 5. Regularity of professional oral hygiene in the examined persons (%)

Regularity of professional oral hygiene	Group 1	Group 2
Once every 6 months or more often	6.5	16.7
Once a year	15.4	56.5
Once every few years	34.5	14.1
Irregular	28.3	7.6
No professional oral hygiene	15.3	5.1
Total	100	100

Note. The probability of an error-free forecast is p <0.05.

 

The survey also enabled the evaluation of the features of individual oral care. Most participants in groups 1 and 2 brush their teeth regularly twice a day (78.1% and 85.2%, respectively) (Table 6).

 

Table 6. Regularity of individual oral hygiene in young people (%)

Regularity of individual oral hygiene	Group 1	Group 2	Probability of an error-free forecast, р
Twice a day	78.1	85.2	р >0.05
Three times a day or more	7.5	13.5	р <0.05
Once a day	9.2	1.3	р <0.05
Irregularly	5.2	0	р <0.05
Total	100	100

 

All respondents used toothpaste (or toothpowder) and a toothbrush (100%) for individual oral hygiene. Additional means (dental floss, irrigator, rinsers, interdental brushes, etc.) were regularly used by 20.7% and 91.2% of respondents in groups 1 and 2, respectively (p <0.05). Approximately 2/3 of the participants used a medium-hard toothbrush.

A larger number of respondents (40.9% and 49.7% in groups 1 and 2, respectively) predominantly used toothpastes with fluoride (p >0.05). Toothpastes with calcium (26.7% and 23.1%, p >0.05), therapeutic and prophylactic toothpaste (8.4% and 7.9%, p >0.05), whitening toothpaste (11.4% and 10.2%, p >0.05), and desensitive toothpaste (12.6% and 9.1%, p >0.05) were used by respondents of groups 1 and 2, respectively. Thus, no significant differences in the type of toothpaste used were identified between the groups.

Brushing teeth only with a toothbrush and toothpaste (without using additional hygiene products) in group 1 took 1–2 min for more than half of the respondents (63.7%). In group 2, most respondents (55.8%) brushed their teeth for 2–3 min (Table 7).

 

Table 7. Time of brushing teeth with a toothbrush and paste in the study groups (%)

Time, min	Group 1	Group 2
<1	20.6	3.2
1–2	63.7	21.3
2–3	10.6	55.8
>3	6.1	19.7
Total	100	100

Note. The probability of an error-free forecast is p <0.05.

 

The overwhelming majority of the respondents (93.6% in group 1 and 95.7% in group 2) considered good individual oral hygiene a necessary factor in maintaining health, which indicates high motivation among young people.

General somatic diseases were also identified. In groups 1 and 2, 16.3% and 14.6% of the respondents had more than one concomitant pathology, respectively (Table 8). No significant differences in the distribution of somatic diseases were found between the study groups.

 

Table 8. Structure of concomitant somatic diseases (%)

Somatic pathology	Group 1	Group 2
No diseases	39.4	45.8
Allergic diseases and immunopathologies	17.6	14.5
Digestive diseases	14.5	10.7
Endocrine diseases	12.3	9.4
Cardiovascular diseases	9.6	7.9
Respiratory diseases	7.2	6.7
Other diseases	17.9	15.8

Note. The probability of an error-free forecast is p >0.05.

 

Regarding the nutritional pattern of the respondents, approximately two-thirds of the respondents in both groups consume sweet foods several times a day (Table 9). Thus, no significant differences in the frequency of consumption of sweet foods (which is considered one of the factors contributing to caries development) were noted between the study groups.

 

Table 9. Frequency of sweet food consumption (%)

Frequency of consumption of sweet foods	Group 1	Group 2
Once a day	12.8	16.4
Several times a day	75.1	70.8
Once every 2–3 days	6.3	4.6
Irregularly	3.6	4.5
No consumption	2.2	3.7
Total	100	100

Note. The probability of an error-free forecast is p >0.05.

 

DISCUSSION

Summary of main research result

In respondents aged 18–44 years, dental caries (94.2%), gingivitis (52.9%), periodontitis (33.9%), and diseases of the pulp and periapical tissues (47.4%) were highly prevalent oral diseases. Unsatisfactory hygienic condition of the oral cavity (p <0.05), visiting the dentist less than once a year (p <0.05), and undergoing professional oral hygiene less than once a year (p <0.05) are among the medical and social factors that determine the high prevalence of dental diseases. Maintaining oral hygiene is facilitated by the use of additional personal hygiene products (p <0.05), and brushing teeth with a toothbrush for >2 min (p <0.05).

Discussion of the main research result

The prevalence of dental caries among the respondents was 94.2%. In addition, teeth with fillings predominate in the CFE structure in both people in need of treatment (F 7.9±0.6) and those with good oral hygiene (F 7.8±0.3). Moreover, high “F” values indicate that dental services in Russia are focused on treatment and not on caries prevention [12]. In group 1, the “C” value was 3.7±0.8.

The prevalence of dental caries among medical university students aged 18–25 years reaches 96%. Moreover, in a previous study, the CFE value of 7.58, which is lower than the indicators obtained in the present study, can be due to the presence of professional education and greater motivation [12]. The caries prevalence rates obtained in the present study (94.2%) are similar to the data from a 2009 study (among Moscow students aged 16–25 years) (98%) [13], which indicates the absence of a clear trend in reducing the incidence.

In this study, the rates of diseases of the pulp and periapical tissues and inflammatory periodontal diseases were 47.4% and 86.8%, respectively.

The comparison of our results with those of other authors is limited by the partial differences in age and social indicators of the studied groups.

According to J.C. Carvalho and U. Schiffner [14], the dental caries rate among the adult population in European countries is >92%, and the CFE values range from 6.6 to 17.6, with an average of 12.1.

In a previous study [15], in Slovenia, 42% of the respondents had good oral hygiene, compared with 5.9% in the present study.

According to epidemiological studies, inflammatory periodontal diseases are present in 90% of the adult population in Russia, approximately 80% in European countries and America, and up to 95% in Southeast Asia [16]. In the present study, the prevalence rates of gingivitis and periodontitis were 86.8%. However, the partial difference in the age of the respondents must be considered when comparing studies.

According to the 2021 WHO recommendations, to reduce the prevalence of oral diseases, a shift should be made from a treatment-oriented approach to a preventive approach [17].

This study identified several medical and social factors that determine the high prevalence of dental diseases, specifically unsatisfactory hygienic condition of the oral cavity (p <0.05), visiting the dentist less than once a year (p <0.05), and professional oral hygiene less than once a year (p <0.05).

Maintaining oral hygiene is facilitated by using additional personal hygiene products (p <0.05) and brushing teeth with a toothbrush for >2 min (p <0.05). Analysis of indicators such as concomitant general somatic pathology, motivation to maintain oral health, and frequency of consumption of sweet foods did not reveal significant differences (p >0.05).

Study limitations

Study limitations include insufficient comparison of our results with those of other authors, which is due to partial differences in the parameters studied, social factors, and age of the participants.

CONCLUSION

In people aged 18–44 years, dental caries (94.2%), inflammatory periodontal diseases (86.8%), and diseases of the pulp and periapical tissues (47.4%) are highly prevalent oral diseases.

Approximately 40.0% of the respondents had no concomitant pathology. Among existing diseases in both groups (17.6% and 14.5%, respectively), allergic diseases and immunopathologies rank first, followed by digestive organs and endocrine system diseases.

Moreover, the majority (91.2%) of the respondents expressed a preference for treatment and follow-up in commercial organizations; however, this is financially accessible to only 49.7% of the respondents. In addition, 80.6% of respondents with good oral hygiene lived in Moscow or in a region in Moscow until 18 years of age, and 37.3% of the respondents were living in regions of the Russian Federation or CIS countries until 18 years of age.

The high prevalence of oral diseases indicates the need to improve a differentiated approach to treatment and preventive measures.

ADDITIONAL INFORMATION

Funding source. This study was not supported by any external sources of funding.

Competing interests. The authors declare that they have no competing interests.

Authors’ contribution. I.S. Kopetskiy, N.V. Polunina — revised the article critically for important intellectual concept; L.V. Pobozhieva — performed the acquisition, clinical research, drafted the article, performed analysis and interpretation of data for the article; Yu.V. Sheveluk — made a substantial contribution to the concept and design of the article, performed the acquisition and analysis of the data for the article; M.K. Makeeva — drafted the article and performed clinical analysis.

About the authors

Igor S. Kopetskiy

N.I. Pirogov Russian National Research Medical University

Email: kopetski@rambler.ru
ORCID iD: 0000-0002-4723-6067
SPIN-code: 8813-9525

MD, Dr. Sci. (Medicine), professor

Russian Federation, Moscow

Natalja V. Polunina

N.I. Pirogov Russian National Research Medical University

Email: nvpol@rambler.ru
ORCID iD: 0000-0001-8772-4631
SPIN-code: 3234-5862

MD, Dr. Sci. (Medicine), professor

Russian Federation, Moscow

Ludmila V. Pobozhieva

N.I. Pirogov Russian National Research Medical University

Email: ludmila-stomatolog@mail.ru
ORCID iD: 0000-0002-6150-0282
SPIN-code: 8253-9519

MD, Cand. Sci. (Medicine), associate professor

Russian Federation, Moscow

Yuliya V. Sheveluk

I.M. Sechenov First Moscow State Medical University

Email: shevelyuk_yu_v@staff.sechenov.ru
ORCID iD: 0000-0002-3854-456X
SPIN-code: 3323-3848

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Maria K. Makeeva

I.M. Sechenov First Moscow State Medical University; Peoples’ Friendship University of Russia named after Patrice Lumumba

Author for correspondence.
Email: makeeva_mk@rudn.university
ORCID iD: 0000-0002-6536-226X
SPIN-code: 2087-1631

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow; Moscow

References

Supplementary files