title: Periodontal disease among indigenous people in the Amazon rain forest.
abstract: BACKGROUND
  People are not all equally susceptible to periodontitis. To understand the epidemiology and natural history of this disease, it is important to study populations with varying genetic backgrounds and environmental exposures.
  
  
  OBJECTIVE
  Characterize the periodontal condition of a sample of indigenous adults in a remote region of the Amazon rain forest and determine the association of periodontal disease with various demographic, behavioral and environmental 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 teeth.
  
  
  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-olds) 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 gingival margin in relation to the cemento-enamel junction changed significantly with age (p<0.0001). Multivariate analysis revealed that increasing age, bleeding on probing and calculus scores were positively associated with mean CAL (p<0.01). Sex, ethnicity, level of modern acculturation, use of coca or tobacco paste, frequency of dental visits and plaque were not associated with mean CAL.
  
  
  CONCLUSIONS
  Periodontal disease in these people was mainly associated with gingival recession rather than deep pockets. Most people had clinical attachment loss but despite poor oral hygiene and extensive gingival inflammation, they did not have very severe periodontal destruction.
authors.affiliation: Oral Health Clinical Research Center, School of Dentistry, University of Minnesota, Minneapolis, USA. mrondero@uop.edu
authors.forename: M
authors.initials: M
authors.lastname: Ronderos
authors.forename: B L
authors.initials: BL
authors.lastname: Pihlstrom
authors.forename: J S
authors.initials: JS
authors.lastname: Hodges
mesh_terms: D000069:Acculturation; D000328:Adult; D000367:Age Factors; D000368:Aged; D003105:Colombia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003728:Dental Calculus / Q000453:epidemiology; D003729:Dental Care / Q000706:statistics & numerical data; D003773:Dental Plaque / Q000453:epidemiology; D004198:Disease Susceptibility; D004781:Environmental Exposure; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005884:Gingival Hemorrhage / Q000453:epidemiology; D005889:Gingival Recession / Q000453:epidemiology; D005891:Gingivitis / Q000453:epidemiology; D006801:Humans; D007199:Indians, South American / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009910:Oral Hygiene; D017622:Periodontal Attachment Loss / Q000453:epidemiology; D010510:Periodontal Diseases / Q000453:epidemiology* / Q000235:genetics; D010514:Periodontal Pocket / Q000453:epidemiology; D012044:Regression Analysis; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D062789:Tobacco Products