Periodontal attachment loss in an urban population of Brazilian adults: Effect of demographic, behavioral, and environmental risk indicators

Background: There is little information about the occurrence and risk factors of periodontal diseases in developing countries. This study describes the clinical attachment loss (CAL) in an adult Brazilian population and performs a risk assessment of demographic, behavioral, and environmental exposures. Methods: A representative sample of 853 dentate individuals (age: 30 to 103 years) was selected by a multistage probability sampling method. The subjects had a full-mouth clinical examination of six sites per tooth and were interviewed using a structured written questionnaire. Results: Seventy-nine percent (79%) and 52% of the subjects and 36% and 16% of the teeth per subject had CAL greater than or equal to5 and greater than or equal to7 mm, respectively. A multivariable model showed that 40 to 49 and 50 years olds had 3.0 and 5.9 times higher risk for moderate CAL and 7.4 and 25.4 times higher risk for severe CAL, compared to the 30 to 39 years olds. Moderate cigarette smokers had a significantly higher risk for moderate (relative risk ratio [RRR] = 2.1) and severe CAL (RRR 3.4), and heavy smokers had a higher risk for moderate (RRR 3.0) and severe CAL (RRR = 8.2) compared to non-smokers. A significantly higher risk for severe CAL was also present in males (RRR = 1.6), subjects with low (RRR = 1.8) or medium socioeconomic status (RRR 1.6), and those with a history of irregular dental visits (RRR = 2.1). Diabetic status and race did not show significant associations with CAL after adjusting for other effects. Conclusions: This Brazilian population had a high occurrence of attachment loss. A population-based strategy that includes the establishment of prevention and health promotion programs targeting high-risk groups is highly desirable for controlling the high occurrence of attachment loss in this population.