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 Table of Contents  
Year : 2017  |  Volume : 5  |  Issue : 2  |  Page : 38-42

Reasons to seek periodontal treatment in a libyan community

1 Department of Periodontal, University of Benghazi, Benghazi, Libya
2 Department of Periodontal, University of Helsinki, Helsinki, Finland
3 Department of Periodontal, Sebha University, Sebha, Libya

Date of Web Publication10-Jul-2017

Correspondence Address:
Ahmed Taher Elhassan
University of Benghazi, Benghazi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/dmr.dmr_5_17

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Background: Periodontitis is a persistent bacterial infection characterized by the progressive destruction of the tooth-supporting structures and can lead to tooth loss. By triggering inflammatory reactions, periodontitis can detrimentally affect systemic health. Periodontitis is a prevalent disease in developed countries like the USA, whereas none is known about its prevalence or the motivations to ask for periodontal treatment in Libya. Aim of the Study: The aim of this study is to understand and analyze the motivation factors to seek periodontal care in the Libyan community; we recorded the chief complaints (CCs) of Libyan patients seeking periodontal treatment in a dental clinic. To the best of our knowledge, this is the first attempt to gather data regarding periodontal disease and the associated CCs in the Libyan community. Materials and Methods: A total of 121 (20–80 years) Libyan patients with periodontitis who sought periodontal care in a private polyclinic were examined. Their CCs were recorded and grouped into true periodontal CC, emergency, esthetic, or referral based. Results: Most of the patients had moderate-to-severe chronic periodontitis. The examiner recorded 170 CCs. They were divided into 14 different CC groups. The most popular CC (32%) was “I was told that I have gum disease,” which is not a true periodontal CC. The second (31%) was “my gum bleeds when I brush my teeth,” which represents a true periodontal CC. Pain constituted only 3% of the patients' complaints. Other true periodontal CCs reported in descending order were: teeth mobility, recession, gum enlargement, bad odor, tooth sensitivity, and gum discoloration. All together constituted 20%. The rest presented for checkup and “cleaning” (9%) or were referred before commencing orthodontic treatment (4%) or implant placement (1%). Conclusion: The major motivation factor to seek periodontal care was found to be the information given to the patient that they had periodontal problems. This emphasizes the crucial role of health-care providers in determining patients with periodontal diseases and raises the awareness level of this silent disease among the Libyan population.

Keywords: Chief complaints, general awareness periodontist, Libya, motivation factors, periodontal care, periodontitis

How to cite this article:
Elhassan AT, Alfakry H, Peeran SW. Reasons to seek periodontal treatment in a libyan community. Dent Med Res 2017;5:38-42

How to cite this URL:
Elhassan AT, Alfakry H, Peeran SW. Reasons to seek periodontal treatment in a libyan community. Dent Med Res [serial online] 2017 [cited 2022 Nov 27];5:38-42. Available from: https://www.dmrjournal.org/text.asp?2017/5/2/38/210120

  Introduction Top

Periodontitis is chronic, multi-bacterial species infection destroying the tooth-supporting structures and if left untreated, often leads to tooth loss. The initiation of the disease arises from disturbances in the dental biofilm and host homeostasis.[1],[2] Furthermore, by causing a state of systemic inflammation, periodontitis can potentially affect a variety of systemic organs, such as liver, cardiovascular system, and lungs and has been linked to diabetes mellitus and cancers.[3],[4],[5],[6]

Despite the higher level of awareness and dental care in developed countries, periodontitis is widely spread among their populations. For instance, in the United States, periodontitis with different forms (mild, moderate, and severe) affects as many as 47.2% (64.7 million) of adults. People aged over 65 years have prevalence rates up to 70.1%.[7]

As Chapple has stated, “Periodontitis is the most common chronic inflammatory disease seen in humans, affecting nearly half of adults in the United Kingdom of whom 60% are over 65 years. It is a major public health problem, causing tooth loss, disability, masticatory dysfunction, and poor nutritional status. Periodontitis also compromises speech, reduces quality of life, and is an escalating burden to the healthcare economy.”[8]

In Libya, the information is limited regarding the prevalence or the awareness level of the periodontal disease. Few studies, conducted in Libya, showed some information regarding periodontal health. For example, in 2012, a study conducted in Sebha/Libya reported that only 1.33% of adult Libyan participants are periodontally healthy and 52.65% had mild periodontitis.[9] Another study demonstrated that 4.9% of young patients (7–16 years) have periodontal pockets.[10] Peeran et al. found that out of 1255 adults aged 18–35 years, only 4.7% are periodontally healthy.[11]

Even among patients with systemic diseases such as type I diabetes, Libyan patients seem to have weak awareness about the disease. Gujjar et al. mentioned that Libyan diabetic patients aged 2–15 years had a high score of plaque index.[12] It has been estimated that for more than 8000 extracted teeth, periodontal disease is the second most cause of tooth loss after dental caries.[13]

In addition to the local and systemic impacts of periodontitis on an individual patient, it has also an economic burden. For instance, the annual cost of periodontal therapy in the US is more than $14 billion (Brown et al. 2002). In Malaysia, the economic burden of managing all cases of periodontitis at the national level from the societal perspective was approximately 32.5 billion Malaysian ringgit, accounting for 3.83% of the 2012 gross domestic product of the country.[14],[15],[16] The Libyan economy depends mainly (more than 90%) on oil. Despite the privilege it may provide, saving expenses that would be spent in combating such a widespread disease is indeed of fundamental value. Early diagnosis and proper treatment of periodontal disease is a primary health-care concern requiring particular attention as difficulty of periodontal disease and its consequences results in significant cost and often requires a special level of dental care.

Therefore, more effort should be made to control this highly world prevalent disease in Libya where this study was conducted. From the authors' perspective, the motivation factors to seek treatment that could be obtained from the patients' chief complaints (CCs) seem to represent a cornerstone step to understand how Libyans think about the disease, hoping to use this information for further understanding periodontal disease among Libyans. Therefore, the main aim of the present study was to know what drives the Libyan patients to visit a periodontist through studying their CCs.

  Materials and Methods Top

The author examined the records of 121 Libyan patients with periodontitis who sought periodontal care in Al-Noor Polyclinic in Tripoli, Libya, between June 2015 and June 2016. Consent form was signed and obtained from the patients. The periodontal diagnosis of each patient was recorded and the CCs were examined and characterized into group of true periodontal CC, esthetic related, emergency, or referral based. The number of patients with a specific CC was divided by the total number of patients multiplied by 100 to get the percentage of each group. The age groups of the patients ranged from 15 to 80 [Table 1]. The number of each age group was divided by the total number of patients multiplied by 100 to get the percentage of each age.
Table 1: Number and percentage of participants in each group according to age

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The periodontal diagnosis was made for each patient according to the international workshop organized by the American Academy of Periodontology in 1999.[17] Chronic periodontitis is considered mild if clinical attachment loss (CAL) was 1–2 mm, moderate if CAL was 3–4 mm, and severe if CAL was ≥5 mm. Aggressive periodontitis is localized if no more than two permanent teeth other than incisors or first molars are involved; otherwise, it was considered generalized aggressive periodontitis.[18]

  Results Top

Varying degrees of periodontitis severity were found in our sample: half of the patients (50%) were moderate, followed by 21% as severe, whereas 15% had mild form of chronic periodontitis. The rest were diagnosed with chronic gingivitis, acute gingivitis, localized aggressive periodontitis, and few with sole trauma from occlusion [Table 2].
Table 2: Number of participants by periodontal diagnosis

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The most common CC was not a true periodontal complaint. The patient showed up based on information given to them from general dentists. They were told that they had periodontal pockets, bone loss, gingival recession, or other periodontal problems. This group constituted 32% of CCs.

The second motivation factor that led Libyan patients to ask for periodontal treatment was bleeding when they brush their teeth or sometimes when they eat some types of food such as apples. Few patients said that they sometimes find or taste blood in their mouths when they wake up in the morning. Bleeding from gingiva was the CC of 31% of the patients.

Around 10% of the participants showed up in the clinic to ask for cleaning “tartar” [Figure 1], [Figure 2], [Figure 3].
Figure 1: Detailed % of CCs of Libyan patients

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Figure 2: Most common motivation factors of Libyan patients to visit a periodontist

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Figure 3: Chief complaints types (Group percentage) of Libyan patients

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Consultation with other dental specialists such as orthodontics comes as the fourth driving reason to visit a periodontist (4%). Tooth migration and mobility was the fifth most common CC, 3%, which is a true periodontal CC, but unfortunately, a late sign of periodontal disease. Gingival recession was the CC of 3%.

Pain, as an emergency CC, was a CC of 3%. Pain complaint was either due to acute gingival infection such as acute necrotizing ulcerative gingivitis, periodontal abscess, and lichen planus or dental pain that was misinterpreted by the patients as periodontal in origin. Gingival enlargement was a CC mostly of pregnant women, or after the completion of orthodontic treatment, it also constituted 3%. Sensitivity to cold after root recession and its exposure to oral cavity were reported by 2% of CC. Two percent of patients complained of halitosis and another 2% of gingival swellings due to abscess. The least reason for seeking periodontal treatment was based on referral from implantologists (1%).

  Discussion Top

Without regular checkup, periodontitis can be asymptomatic for a long time and signs of inflammation may be missing even in the severe form of periodontitis. This leads to tooth loss, less quality of life, and possible systemic consequences. Fortunately, periodontitis is treatable if detected early. This would require phase I therapy which involves patients' education, scaling, and root planning that can be performed by general dentists.[19],[20] Therefore, the goal must be set to help patients to detect early signs of the disease. From the author's perspective, to accomplish this goal among Libyans, we need to assist what might drive Libyan patients to seek periodontal care and build on these motivational factors to better educate the patients about the disease signs in the future and maximize their self-care efficiency.

The first CC of Libyan patients in regard to periodontal diseases was information given to them by their dentists about their periodontal condition. The patients were surprised to hear that they had bone loss or periodontal pockets and they should see a periodontist. In fact, this is not unique to Libyan patients as studies in developed countries showed that information given to patients by their dentists was the first reason to start periodontal treatment. According to Demetriou et al., this can be attributed to the slow progression of the disease, which mostly renders it unnoticeable by many patients, especially in early stages.[21]

Although most of the patients have seen a periodontist based on referral from dentists/dental specialist, more effort is needed to refer patients when early disease signs appear as some of the patients with advanced periodontal diseases have been seen by general dentists without being referred. This may be due to the belief of general dentists that they have the ability to treat such patients in their clinics.[22]

Chief complaints of patients

The second CC, in contrast to the first, is a true periodontal CC, as it is gingival bleeding that is noticed by the patients during brushing, eating, or tasted in their mouths in the morning. Bleeding from the gingiva is a common symptom and sign for periodontal diseases. It indicates an ongoing active periodontal inflammation that could be gingivitis, periodontitis, hormonal disturbance, medications side effect, systemic diseases, or malignancy, for example, leukemia.[23] The second CCs, bleeding from gingiva, is also the second most periodontal CC in developed countries and is likewise in Libya.[24]

The third reason why Libyan patients seek periodontal care is for scaling, “cleaning of their teeth.” This group of patients represents people who have better awareness about the importance and need of their dental and periodontal health and the necessity of regular dental checkup. The next reason was an orthodontic referral to examine patients before starting orthodontic treatment. We noted that some orthodontists referred their patients late during orthodontic treatment when the patients had developed signs of advanced periodontal disease.

Tooth migration and mobility was the fifth most common CC. Tooth migration can be due to bone loss or loss of tooth support, trauma from occlusion, hypofunction, periodontal surgery temporarily increases tooth mobility, pathology of jaws such as tumors, cysts, osteomyelitis, and the spread of inflammation from an acute periapical abscess may increase tooth mobility in the absence of periodontal disease.[25]

In modern life, esthetics is crucial to a component of healthy living. Gingival recession was an esthetic concern of some patients;[26] however, most patients neither knew about the bone loss that is associated with the gingival recession nor the possibility of tooth loss if periodontal disease is neglected. The reason why pain comes late in the list is due to the chronicity and the slow progression of most of periodontal diseases. As it might seem beneficial, indeed it carries a negative side when patients do not notice the course of the disease until it reaches its late stage where treatment becomes compromised. [Table 3] shows the CCs in descending order based on true periodontal CC, esthetic, emergency, or referral.
Table 3: Periodontal chief complaints

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  Conclusion Top

Periodontal CCs of Libyan patients give us an understanding regarding the awareness level of the periodontal disease among them. In addition, it explains the motivating factors among Libyans to seek periodontal treatment, satisfaction with treatment, and the lack of the referral among some with periodontal patients until advanced progression of periodontal disease.

The most common CC was based on advice given from general dentist or other dental specialists to the patients regarding their periodontal health. True periodontal CC such as bleeding was a noticeable driving factor for treatment. Few patients ask for periodontal care “cleaning or checkup,” and this group represents the patients being aware. Few others ask for treatment due to pain, esthetic concern, or late when they develop advanced periodontal symptoms.


We would like to thank Dr. Ahmed Elmusrati, BDS Ph.D., for contributing valuable expertise, especially for his careful review of this paper.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3]

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