Prevalence of Gingivitis among Malian Children

Objective: To determine the prevalence of gingivitis among Malian children in Bamako, Mali. Material and Methods: This cross-sectional study evaluated 2640 children aged between 3 to 14 years old and two examiners collected the data. The gingival index was used to determine the degree of gingival. Gingival inflammation has been classified localized and / or generalized according to site rate achieved. Descriptive statistics were used to calculate the absolute and relative frequencies. Results: The prevalence of gingivitis was 87.5%. Regarding the distribution according to sex, the girls presented 60.6% while the boys 39.4%, with a sex ratio of 0.6. The most represented age group was 11-14 years old with 52.5% of cases. Plaque-induced gingivitis was the most common (58.2%), while moderate gingival inflammation affected 67% of the students with localized gingival inflammation involving 64.7% of the participants. Conclusion: The prevalence of gingivitis was high, so that early and correct management of this condition in children avoids complications and requires good oral hygiene.


Introduction
The health of children is one of the first concerns of public health, especially in developing countries where infectious diseases still cause casualties among the infant population.However in these countries prevention and health programs are rare or non-existent in some places.Gingivitis is a reversible type of periodontal disease in which inflammation is limited to the gum without further destruction of the supporting tissues of the tooth.It is considered the second most frequent oral disease following dental caries, affecting more than 75% of the world's population [1].
The confusion when it comes to diagnosing gingivitis comes from the fact that all diseases affecting the gum have historically been referred to as gingivitis, whether atrophy, neoplasm or trivial inflammation in response to bacterial plaque.Gum disease is not a single disease, but rather a spectrum of disease that results from distinct disease processes.Thus, the term gingival disease has replaced that of gingivitis to design any localized damage to the gum, whatever its origin.
Plaque-induced gingivitis is the most common type of gingivitis.Gingival inflammation is exacerbated during puberty due to the expression of intracellular steroid hormone receptors in human gingival cells and increased levels of steroid hormones [3].
Untreated gingivitis can progress to periodontitis, a common cause of tooth loss.In Mali, and particularly at the Children's Dental Center, the prevalence of gingivitis in children has never been studied.It is in this context that this work was carried out with the objective of determining the prevalence of gingivitis among children who came for consultation in the Children's Dental Center of Bamako, Mali.

Study Design
This was a cross-sectional and descriptive study lasting 6 months from January 1st to June 30th, 2015 at the Bamako Children's Dental Center, Mali.

Sampling and Data Collection
All children seen in consultation during the study period were evaluated.The data collection was done on the basis of a fact sheet developed for this purpose according to the objectives of the study.
The survey was filled out by two dental surgeons and their assistants all calibrated to master and differentiate the symptoms of gingivitis before the start of the investigation that allowed us to make the diagnosis (Table 1).The gingival index was used to determine the degree of gingival inflammation [4,5]: 0 = no sign of inflammation; 1 = inflammation slight (slight change in color, slight edema); 2 = moderate inflammation (redness, edema, hyperplasia and bleeding on probing); 3 = severe inflammation (redness, swelling, ulceration and spontaneous bleeding tendency).Gingival inflammation has been classified localized and / or generalized according to site rate achieved (localized if less than 30% and generalized more than 30%).

Data Analysis
The data collected were listed on Excel spreadsheet and processed by Epi-Info Software

Results
A total of 2640 patients were evaluated and 2312 patients presented gingivitis, a prevalence of 87.5% (Table 2).Regarding the distribution according to sex, the girls presented 60.6% while the boys 39.4%, with a sex ratio of 0.6.The most represented age group was 11-14 years old with 52.5% of cases.Plaque-induced gingivitis was the most common (58.2%), while moderate gingival inflammation affected 67% of the students with localized gingival inflammation involving 64.7% of the participants.

Discussion
This descriptive and cross-sectional study has made it possible to determine the prevalence of gingivitis in children consulted at the Bamako Dental Center in Mali.The prevalence of gengivitis was 87.5% and this result is comparable to observed in Southern Jordan (70.2%) [6], and in Puerto Rico who had reported a prevalence of 80.4% [7].This high prevalence could be explained by the phenomena related to teething (dental eruption) and with poor oral hygiene [8].
In this study, females were more affected than males, with a sex ratio (male / female) of 0.6.
This result is contrary to observed in Mali, in which there was a predominance of males, with a ratio between the sexes of 1:0 [9].A study conducted in Dakar reported 53% of boys versus 47% of girls in school children aged 3-15 [10], while another research team in Quebec has found 49% girls and 51% boys, both in Grade 2 and Grade 6 [11].This difference could be explained by the choice of the place of study (schools and health center).The most represented age group was 11-14 years with 52.5% of cases.This result is compared to that described by other authors in Jordan [6] and in Puerto Rico [7] and, therefore, may be due to the fact that this age group corresponds to the mixed dentition or we have physiological and pathological phenomena of eruption and resorption of temporary and permanent teeth.
There are several epidemiological studies in children and adolescents on periodontal disease.
Epidemiological surveys are essential for the surveillance of oral diseases such as periodontal diseases through the diagnosis of these diseases, it is possible to guide decision making in the implementation of effective preventive and curative policies, so that adolescents can reach adulthood with periodontal health [12].
Plaque-induced gingivitis was the most common finding, with moderate gingival inflammation and localized.Among Jordanian children, it was reported a prevalence of 29.8% healthy gingiva (no inflammation), 38.5% mild gingival inflammation, 31.4% moderate gingival inflammation and 0.3% severe gingival inflammation [6].In Puerto Rico, it was found that 60.8% of the children had generalized gingival inflammation [7].
A recent study in Algeria, involving children of 6, 12 and 15 years old, reported a prevalence dental caries of 74.1% and 46.4% of children present localized gingivitis, more common at 12 years and 15 years than at 6 years [13].Among Canadian children, the authors found that students had gingivitis in 50% of cases and had gingival bleeding in one in five students in second grade and almost one-third in sixth grade [11].In Senegal, 73.4% of Comorian students had calculus, while only 15.8% had healthy gums, and girls had a better periodontal state than the boys with (healthy gingiva: 21% versus 11%, gingival bleeding: 9.5% versus 12%, dental calculus: 69.5% versus 77%).
Periodontal status was not different between urban and rural students [14].Previous authors in northern Lebanon found that 50.9% of children aged 12 had localized gingivitis and 12.3% had generalized gingivitis.The dental malpositions were mentioned in 40,1% of the cases [15].Among Brazilian adolescents, the prevalence of healthiness was only 1.6%, and gingival bleeding and presence of calculus were the most frequent changes, 34.4% and 37.8%, respectively [12].
This study has a limitation related to the low level of evidence of cross-sectional studies in general, however the results remain useful for further studies with a high level of scientific evidence.

Conclusion
In this study, we found a high prevalence of gingivitis, possibly due to a lack of oral hygiene.
Proper daily elimination of dental plaque prevents periodontal disease (periodontal disease and gingivitis) and dental caries.The most common and effective way is to promote oral hygiene; it is therefore recommended to adopt brushing as a habit, which is repeated every morning and evening at least twice a day.In addition to hygiene, frequent brushing with fluoride toothpaste increases the resistance of the tooth against decay.Brushing teeth and other behaviors that make up the lifestyle of young people can have a direct or indirect impact on their health in the short or long term.

version 3 . 5 . 3 (
CDC, Atlanta, USA).Descriptive statistics were used to calculate the absolute and relative frequencies.Ethical AspectsThis study followed recommendations of the Declaration of Helsinki and was approved by the Military Hospital of Bamako Ethics Research Committee.Prior to examinations, parents / legal guardians of research subjects were clarified about the objectives of the study and agreed to their participation by signing the Free and Informed Consent Form.