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Year : 2022  |  Volume : 20  |  Issue : 2  |  Page : 147-152

The impact of lifestyles on the periodontal health among 35–44 years old adult population in Lucknow district: A cross-sectional study

1 Departments of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India
2 Department of Public Health Dentistry, Anil Neerukonda Institute of Dental Sciences, Visakhapatnam, Andhra Pradesh, India
3 Department of Oral Medicine and Radiology, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission01-Feb-2021
Date of Decision31-Dec-2021
Date of Acceptance18-Jan-2022
Date of Web Publication8-Jun-2022

Correspondence Address:
Ila Verma
Department of Public Health Dentistry, Sardar Patel Post Graduate Institute of Dental and Medical Sciences, Lucknow - 226 025, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiaphd.jiaphd_13_21

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Background: Periodontal disorder continues to be a major issue worldwide. It is closely related to lifestyles and strongly determined by behavioral factors. Aim: To assess the different lifestyle factors and overall lifestyle variables affecting the periodontal health among 35–44 years old adult population in Lucknow district. Objectives: (1) To determine the influence of various lifestyle factors on adult periodontal health among urban and rural population. (2) To measure the effect on periodontal adult health of the overall lifestyle variables measured by the health practice index (HPI). Materials and Methods: A cross-sectional research w as performed on 400 participants aged 35–44 years, consisting of a standardized questionnaire on HPI, oral health-related behavior, and personal behaviors, as well as sociodemographic variables. Clinical examination for periodontal status was done by recording the loss of attachment (LOA) scores using the community periodontal index (WHO-2013). Statistical Analysis: Statistical Package for the Social Sciences (SPSS) software version 21.0 was used for statistical analysis. Statistical analysis was done using the Chi-square test and multivariate regression analysis. Results: The variables that showed an independent association with periodontitis were location, smoking, sleeping hours, physical exercise, eating breakfast, nutritional balance, mental stress with LOA of periodontal tissues; the results of multivariate regression analysis are statistically significant (P < 0.001). Conclusions: This study supports an overall management of chronic periodontitis using different lifestyles. Vital public health action is needed on factors that define unhealthy lifestyle habits across the community, which is achievable through promoting healthy lifestyles through patient engagement in self-care.

Keywords: Health practice index, lifestyle, periodontal disease, urban and rural

How to cite this article:
Verma I, Reddy L V, Verma A, Kashyap P, Sanaullah M, Adwani J. The impact of lifestyles on the periodontal health among 35–44 years old adult population in Lucknow district: A cross-sectional study. J Indian Assoc Public Health Dent 2022;20:147-52

How to cite this URL:
Verma I, Reddy L V, Verma A, Kashyap P, Sanaullah M, Adwani J. The impact of lifestyles on the periodontal health among 35–44 years old adult population in Lucknow district: A cross-sectional study. J Indian Assoc Public Health Dent [serial online] 2022 [cited 2023 Sep 30];20:147-52. Available from: https://journals.lww.com/aphd/pages/default.aspx/text.asp?2022/20/2/147/346877

  Introduction Top

Periodontal disorder is a chronic inflammatory condition affecting the teeth and underlying tissues. The periodontal disease initially occurs as gingivitis observed as reversible inflamed soft tissue that induces gingival bleeding and swelling of the periodontal tissues.[1] Gingivitis can cause periodontitis in susceptible people with an impaired immune response, which gradually destroys the support of the periodontal tissue and the bone covering the teeth.[2] This loss of periodontal support, as a clinical attachment loss, periodontal pocketing, gingival bleeding, and radiographic measured bone loss, is characterized by periodontitis.[1] Periodontal disease is mainly caused by poor oral-hygienic conditions that contribute to a buildup of pathogenic microbial biofilm (Plaque).[2]

The highest prevalence of periodontal disease reported was found to be 97.51%.[3] The prevalence of two forms of periodontal disease, i.e., chronic periodontitis and aggressive periodontitis, is 1.5% and 0.36%, respectively.[3] Some areas of states such as West Bengal, Uttar Pradesh, and Assam have registered a prevalence rate of periodontal disease in their general population of more than 85%.[3]

Person and social lifestyle or way of living have constituted the conditions to which people have been subjected all their lives from birth to the present time. Lifestyles are considered to be linked to the condition and mortality of physical health and to recognize threats to cancer growth, circulatory diseases, and other chronic diseases.[4] A model for generalized periodontitis etiology is proposed, which focuses on the fundamental function of personal risk factors such as poor lifestyle factors and negative psychosocial conditions. These personal factors may cause periodontal disease to develop.[5] In research by Locker et al. and Sakki et al., ill-healthy lifestyles are associated with an increased incidence of periodontitis.[6],[7] Better immunity was documented in people with healthy lifestyles with higher levels of naturally occurring killer cells, while poor lifestyles contributed to increased or suppressed immunoglobulin.[8],[9]

Since the idea of lifestyle emphasizes the individual's personal characteristics, actions can be analyzed in a broader context how a person's life may create behavioral habits that are positive or harmful to health. To boost health, different lifestyles should be examined as risk factors, and steps should be taken to rectify them.[10] However, there is no international consensus on standardized lifestyle assessment methods. The decision on lifestyle interventions related to health depends on the relevant research concern. The objects measuring the style of life should be selected for the purpose of the study.[11] However, the Breslow seven patterns are widely used in the consideration of general health behavior (sufficient sleep, not smoking, moderate alcohol consumption, healthy weight, daily exercise, breakfast, not eating between meals).[12] To research the combined influences of different health risk factors, it is not only important to analyze individual lifestyle factors that can affect periodontal status but also to study overall lifestyles.[13] The role of such factors in the prevention and management of many chronic problems, including periodontal disease, should be clarified by such an study.

Therefore, the present cross-sectional study was undertaken with an attempt to assess the different lifestyle factors such as demographics of study subjects, personal habits, habits mentioned in health practice index (HPI), and an overall lifestyle variable, i.e., age, location, smoking, alcohol drinking, sleeping hours, working hours, physical exercise, eating breakfast, nutritional balance, and mental stress which is calculated by HPI affecting the periodontal health status of the adult population in the Lucknow district.

  Materials and Methods Top

A cross-sectional study was designed to evaluate the different lifestyle factors and overall lifestyle variables affecting the periodontal health among 35–44 years old adult population in Lucknow district for a period of 6 months. Before the start of the study, ethical clearance (PHD/02/1819/IEC) was obtained from the institutional ethical committee, and informed consent was obtained from all the participants of the study. The study was conducted among 35–44 years old in the rural and urban population of Lucknow district. The subjects were taken from household survey. The sample size needed to carry out this study was calculated, taking confidence level at 95% (Z, standard value of 1.96) and margin of error at 5% (d, standard value of 0.05). The formula for sample size calculation used was

The sample size was estimated to be 400. A pilot study was conducted on 40 subjects (10% of total sample) aged 35–44 years to check the validity of the questionnaire and operational feasibility of the study. Cronbach's alpha was applied for reliability of the questionnaire and it was found to be 0.84. No adjustments were found to be necessary.

The sample was selected by a multistage cluster random sampling technique. In the first stage, Lucknow was divided geographically into four zones, i.e., East, West, North, and South. Approximately 22 wards came under each of these geographic areas. In the second stage, one ward was randomly selected from each geographical area. A list of all the wards from the four geographical areas was obtained from Census Enumeration Areas Data 2011. In the third stage, the selection of 35–44 years (according to the WHO basic oral health survey, this age group is the standard monitoring group for periodontal disease) adults was done by selecting an equal number of representative samples through the household survey. Thus, a total of 200 adults from urban and 200 from rural areas of both the genders meeting the following inclusion and exclusion criteria were examined. The study procedure was explained to all the subjects and those who gave consent participate in the study were included as per the inclusion and exclusion criteria. Participants who were willing to participate, between the age group of 35–44 years, and those who were able to read the questionnaire were included in the study.

Those participants who were unable to engage in orthodontic care were excluded. Participants with any medically unstable conditions that contraindicate oral examination such as infective endocarditis and HIV/AIDS were excluded, as well as individuals with conditions that could impact periodontal health such as diabetes, pregnancy, anti inflammatory disease were also excluded. The study also omitted anti-inflammatory drugs or tetracycline or Vitamin C supplements from the last 6 months, drugs that may induce gingival enlargement, such as Phenytoin (Dilantin), and various calcium channel blocker agents such as amlodipine, nifedipine, and cyclosporine.

The study was carried out by a single investigator who was trained and calibrated in the method of recording the Community Periodontal Index with Loss of Attachment (LOA) (WHO 2013). Before the present study was conducted, the investigator practised the method recording of the above-mentioned Community Periodontal Index with LOA (WHO 2013) on 40 children (10% of the total sample) aged 35–44-year old adult. Subjects were re-examined on successive days using the same diagnostic criteria. The result of two examinations was compared to obtain an estimate of the extent and nature of diagnostic variability measured by kappa statistics and the value was 0.84. The recorder in the study was also trained in the department of public health dentistry.

Survey pro forma consists of a predesigned and pretested questionnaire which consists of four sections which include demographic details, socioeconomic status with the help of Kuppuswamy Socioeconomic Status Scale, 2018. It also includes oral health-related behavior and personal habits such as frequency of dental visits, device of cleaning, frequency of cleaning, method of cleaning, and the presence or absence of habits such as tobacco and pan chewing, and the fourth section of the questionnaire was an “eight-item HPI scale” for the evaluation of the total lifestyle, developed by Morimoto, i.e., the eight items on the self-administered questionnaire.

LOA of periodontal tissues was recorded using the community periodontal index (WHO 2013). In periodontitis, case-defining requirement is considered to be LOA with at least one site ≥4 mm.

Statistical analysis

The collected data were coded, tabulated, and subjected to appropriate statistical analysis. IBM Corp. Released 2012.IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp was used for statistical analysis. Statistical analysis was done using the Chi-square test and multivariate regression analysis.

Multivariate logistic regression analysis was used to test the independent combination of different lifestyle variables with LoA of periodontal tissue.

  Results Top

Distribution of study subjects according to various sociodemographic details

The subjects were divided into urban and rural on the basis of the geographic location to which they belonged. Among 400 participants (200 urban and 200 rural), 48.9% were males and 50.9% were females in urban area and 51.1% were males and 49.1% were females among rural participants. Professionals were represented by 38.6% in urban areas, while only 1% in rural areas. Regarding the socioeconomic status, majority of them were in the upper class (93.3%) in urban population and 6.7% in rural population.

Difference between urban and rural groups of the study population for overall lifestyle is statistically significant (P < 0.0251), as shown in [Table 1] and [Graph 1] HPI.
Table 1: Overall lifestyles (combined health practice index variable) of the study participants between the urban and rural groups

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[Table 2] shows independent association of various components of lifestyle, i.e., smoking, alcohol drinking, sleeping hours, working hours, physical exercise, eating breakfast, nutritional balance, mental stress with LOA of periodontal tissues, the results are statistically significant (P < 0.001).
Table 2: Independent association of various components of lifestyle with loss of attachment of periodontal tissues, the results of multivariate regression analysis

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[Table 3] shows independent association of lifestyles (combined HPI variable) with LOA of periodontal tissues, the results are statistically significant (P < 0.001). Participants with poor lifestyles experienced nearly twice LOA prevalence relative to those with good lifestyles (adjusted odd's ratio 2.56).
Table 3: Independent association of lifestyles (combined health practice index variable) with loss of attachment of periodontal tissues, the results of multivariate regression analysis

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  Discussion Top

This study reports the periodontal status of the urban and rural population of a household survey. The goal of this study was to examine the effect on the periodontal health of adults of the different lifestyle factors and overall lifestyles. Most cross-sectional surveys have used community periodontal index (CPI) for quick, cost-effective, time-consuming evaluations of periodontal disease. Therefore, the CPI index variable was used in the sampled population for the estimation of periodontal disease prevalence.

It included a broader range of variables, such as demographics for study participants, oral health behavior, personal habits, HPI habits, and lifestyles in general (calculated by HPI). The results of the multivariate regression analysis showed that independently of periodontitis (measured in connexion with LOA), the following variables were found, i.e., location, smoking, number of sleeping hours per night, physical activity, and the general bad living styles.

The age group of 35–44 years was selected for the present study as it helps to assess the level of severe periodontal involvement. The economic and sociological measure of work experience, social position, and economic influence formed by an individual's income, education, and occupation has been recognized as the socioeconomic status of an individual or family. Inequalities in socioeconomic status have been deemed a fundamental health problem. The greater a person's socioeconomic status, the better health, the less disability, the less sickness, the longer life they will live.

In the current research, the location was identified as an important demographic factor which may play a role in the development of periodontal disease. The rural participants were inferred to have twice the incidence of periodontitis than the urban participants. This was similar to the studies by Bali et al.[14] from the National Oral Health Survey and Fluoride Mapping (2002–2003) and the research performed by Shah et al.[15] In the present analysis, the lower periodontal destruction among the urban participants can be related to their better behavior related to oral health. This may be attributed to improved schooling, higher jobs, higher wages, access to health care facilities, and increased knowledge among the urban population. However, this result did not correspond to the findings of Singh and Soni,[16] which stated that, compared to rural subjects, urban subjects had a higher prevalence of periodontitis.

Smokers were 1.23 times more susceptible to periodontitis than nonsmokers, as seen in personal and periodontitis habits [Table 2]. This result was consistent with most research that found smoking to be a contributing factor to poor periodontal health and a very significant risk factor for periodontal diseases. Smoking suppresses the host defense mechanism and, in turn, fosters the progression of periodontal disease. On the contrary, Croucher et al.[17] suggested that smoking tobacco was not a relevant factor for periodontitis.

Alcohol consumption is considered an independent adjustable risk factor for periodontitis.[18] In the multivariate review of the present study, the association between alcohol consumption and periodontitis was uncertain due to the existence of a large CI between the two. An insufficient sample of daily alcohol consumers in our research may be the explanation for this.

An important effect on periodontal disease was also shown by a lack of physical activity. Participants who did not perform any kind of workout were 1.91 times more likely than those who did have LOA. Similarly, Merchant et al.[19] recorded that periodontal health can be impacted by the benefits of a physically active lifestyle. This finding is consistent with the reports submitted by Al-Zahrani et al.[20]

In this study, lack of sleep was reported as another major lifestyle factor that may play a role in the development of periodontal disease. There was less periodontal disease (LOA) among the participants who slept for 7–8 h/day than those who slept for 6 h or less a day. However, studies that have observed hours of sleep as an independent factor influencing periodontal health are uncommon, in line with the study conducted by Kibayashi et al.[21] We may speculate from this study that a lack of sleep can weaken the immune response of the body, which can contribute to the development of periodontal disease. The other possible explanation may be that lack of sleep may serve as a proxy predictor for conditions of stress or overwork.

In the multivariate analysis, the effect of stress and the number of working hours a day was decreased to the degree that it was not significantly correlated with periodontitis in the current study. This result differs from Marcenes and Sheiham[22] research, Linden et al.,[23] which reported a substantial association between periodontal health status and mental demand associated with work. Likewise, studies conducted by Wimmer et al.[24] and Pistorius et al.[25] have shown that mental stress can lead to periodontal disease. A link between stress and periodontal health was not identified in the present study, similar to the study performed by Aleksejuniené et al.,[26] but there is reason to believe that such an association is possible. In the current study, the lack of correlation may be attributed to social desirability bias that may occur as a result of self-assessment of stress levels.

In addition to the habits included in the HPI, tobacco-chewing and paan-chewing behaviors were also assessed in the present study as these habits are central to the study area's community. However, the association of chewing tobacco with the LOA of periodontal tissues of the subjects examined was not found to be relevant, which was in agreement with Sinusas et al.[27] Nevertheless, we conclude that smokeless tobacco may be an important risk factor for periodontal disease.[28] As reported by Robertson et al.,[29] the use of smokeless tobacco is known to cause a painless loss of gingival tissues and alveolar bone degradation in the region of chronic tobacco contact. This is a consequence of collagen breakdown due to increased collagenase release.

The composite lifestyle component used in the study reflected health-related aspects of the overall lifestyle. To achieve a more detailed view of the variable than a single trait of behavior using Morimoto's HPI, the variable was used here.[8] The prevalence of LOA among participants with poor lifestyles was almost twice that found in participants with good lifestyles. This was consistent with the results stated by Sakki et al.,[7] Kibayashi et al.[21] and Gundala and Chava,[30] which also suggested that periodontal health was independently correlated with lifestyle. As compared to those with an unhealthy lifestyle, the prevalence of periodontitis for those with a healthier lifestyle was substantially lower.

  Conclusions Top

A general view of wellbeing is strengthened by the idea of lifestyle. The correlation of lifestyle with periodontitis supports the notion that the treatment of chronic diseases should take into account actions. It is important to take public health action on factors that define unhealthy lifestyle habits across the population. However, this can only be made possible through the patient's interest in self-care through the promotion of healthier lifestyles. Negating addiction to orally abusive drugs, consuming breakfast daily, eating a healthy diet, and reducing stress contribute to a healthier lifestyle overall. Together with sleeping at least 7–8 h a night and operating for 8–9 h and ample physical exercise, these variables will help patients improve or preserve their oral health for years to come.


Strategies and policies that advocate periodontal health are desperately needed. From an understanding of how much activity and what particular steps dentists should take to minimize the risk of periodontal disease, these policies and procedures should be driven by the routine nature of everyday life, with all its own pleasures, demands, restrictions, and possible rewards and threats. Several techniques can be considered to affect the individual and society's periodontal health, such as:

  • To promote prevention which helps in changing behavior
  • Enhancing literacy in oral health care
  • Engineer more efficient, safe chemotherapeutic agents
  • Innovating the technology of plaque removal
  • Ascertain risk factors for patients
  • Early detection, useful diagnostics, and noninvasive treatment should be carried out
  • Business-community participation
  • Periodontal Health implementation in progress.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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