Periodontal disease among indigenous people in the Amazon rain forest

Background: People are not all equally susceptible to periodontitis. To und erstand the epidemiology and natural history of this disease, it is importa nt to study populations with varying genetic backgrounds and environmental exposures. Aim: Characterize the periodontal condition of a sample of indigenous adult s in a remote region of the Amazon rain forest and determine the associatio n of periodontal disease with various demographic, behavioral and environme ntal factors. Methods: A cross-sectional evaluation of 244 subjects aged 20-70 years was conducted. Pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque and calculus were assessed for the Ramfjord index tee th. Results: These people had high levels of plaque, calculus and BOP The mean PD was rather shallow (2.45 mm in 20-29 year-olds to 2.73 mm in 50+ year-ol ds) and did not increase significantly with age. Mean CAL (0.57 mm in 20-29 year-olds and 2.26 mm in 50+ year-olds) and mean location of the free ging ival margin in relation to the cemento-enamel junction changed significantl y with age (p <0.0001). Multivariate analysis revealed that increasing age, bleeding on probing and calculus scores were positively associated with me an CAL (P <0.01). Sex, ethnicity, level of modern acculturation, use of coc a or tobacco paste, frequency of dental visits and plaque were not associat ed with mean CAL. Conclusions: Periodontal disease in these people was mainly associated with gingival recession rather than deep pockets. Most people had clinical atta chment loss but despite poor oral hygiene and extensive gingival inflammati on, they did not have very severe periodontal destruction.