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Bangladesh Journal of Medical Science Vol.09 No.3 Jul’10 

*Corresponds to: Dr. Shaju Jacob P, Department of Periodontics and Oral Implantology, Chhattisgarh 

Dental College and Research Institute, Sundara, Rajnandgaon, Chhattisgarh 491441, India. Fax no:

00917744-281930. Email: shajujacob@yahoo.com.

Review article

Periodontitis in India and Bangladesh. Need for a population based 

approach in epidemiological surveys. A Literature review. 

P Shaju Jacob* 

Abstract

Background: Early surveys showed people of India and its neighbors to be highly 

susceptible to periodontitis. This was based on the early surveys which estimated a higher 

prevalence. Aim: This paper reviews the prevalence of periodontitis in India and 

Bangladesh and attempts to find out why the populations of the Indian subcontinent were 

considered more susceptible to periodontitis. Settings and design: Review of periodontitis 

prevalence studies on the Indian and Bangladeshi population. Methods and material:

After identifying articles from Pub Med, DAOJ and hand searching, the epidemiology of 

periodontitis is reviewed. Results and conclusion: This review identifies that very few 

studies have been done on representative population. Yet it can be certainly concluded that 

there is a high prevalence of periodontitis in the adults and the economically weak 

population which can be reduced by adopting preventive public health strategies. 

Conclusions: Standardized population based studies in a representative population with a 

robust design to identify the true prevalence of periodontitis is needed. 

Keywords: Periodontitis, India, Bangladesh, epidemiology, prevalence. 

Introduction

India and Bangladesh share more in 

common than being two of the most 

populous nations in terms of population 

density. Culture, trade, security are some 

of the areas where the two countries meet. 

The two countries are also considered to be 

affected by periodontitis, the major reason 

for tooth loss in adults, which is higher 

than the western nations.  

Oral health has been neglected for long in 

India. With the formulation of the Oral 

health policy India has started recognizing 

the benefits of having a healthy population 

including in oral health. In India, dental 

care scenario is unique
1
. At present there 

are more than 267 dental schools, 

producing approximately 19,000 dental 

graduates/year and almost 3000 specialists. 

Bangladesh has 14 dental schools 

(Bangladesh Medical and Dental Council). 

The dental schools are major players for 

inexpensive oral care and also offer 

excellent tertiary care. On the other hand, 

even the most basic oral health education, 

simple interventions like pain relief, 

emergency care for acute infection and 

trauma are not available to the vast 

majority of population, especially in rural 

area. There is variation in the periodontitis 

prevalence as reflected in the two major 

surveys conducted 
1, 2

. Lack of 

epidemiological data on representative 

rural population compounds the problem 

further. Albandar
3
 in an overview 

concluded that subjects of Asian ethnicity 

had the third highest prevalence of 

periodontitis. The aim of this review is to 

find the prevalence of periodontitis in India 

and Bangladesh. 

Method 

Using keywords “Periodontitis” and 

“India”, “Periodontal” and “India” and 

“Periodontitis” and “Bangladesh”, 

“Periodontal” and “Bangladesh” various 

index were searched including PubMed 

and medIND. Search for India gave 163 

articles while Bangladesh had 12 articles. 

Studies which gave prevalence data on 



Shaju Jacob P 

125 

periodontitis were selected and thus 13 

articles were selected for the review.  

In this review moderate periodontitis is 

considered if a person has at least one site 

4mm and severe periodontitis at least one 

site 6mm of probing depth.  

Greene
4
 conducted one of the very earliest 

prevalence studies in India. The 

periodontal index (Russell, 1956) was 

used. The survey was on the school 

population in a low socio economic area. 

Ninety-seven per cent of the 11-17 year old 

persons examined had overt evidence of 

periodontal disease, while fewer than 2 per 

cent of the total had obvious periodontal 

pockets. All the 63 persons over 17 years 

of age had overt gingival inflammation, 

and 19persons (30.2%) per cent, had 

obvious periodontal pockets. Persons with 

obvious periodontal pocket (periodontitis) 

were 0.2% in 11 yrs, 0.4 in 13 years, 1%in 

15 and 6% in 17 years group. 

Ramfjord
5
 observed that there is 100% 

prevalence of periodontal disease 

(including gingivitis) in India. At 17 years 

10% of Indian boys had periodontitis. This 

periodontitis was due to accumulation of 

calculus, plaque and debris rather than due 

to age, sex, geography, economic status or 

nutrition.    

Sanjana et. al
6
 did a study on Bombay 

residents in 1956. 83.2% had signs of 

periodontal disease.  

National Oral Health Survey and 

Flouride Mapping, 2002-2003, Dental

Council of India, New Delhi, 2004: this is 

the first ever national level epidemiological 

survey done in India. The survey was to 

collect information covering various 

dimensions of oral health including 

prevalence of oral health problems. 

Community Periodontal Index (CPI) was 

used for disease assessment. The 

prevalence of periodontal disease increased 

with age. Moderate periodontitis was seen 

in 17.5% of 35-44yr old, and 21.4% in 65-

74 yr old, whereas severe disease defined 

as at least one tooth with >6mm probing 

depth was 7.8% in 35-44yr old, and 18.1% 

in 65-74 yr old. No marked gender 

differentials were observed and marginally 

higher prevalence seen in rural subjects. 

This survey gave a reliable baseline data at 

a national and state level.  

Oral Health in India: A report of the 

multicentric study
1
, Directorate General of 

Health Services, Ministry of Health and 

Family Welfare, Government of India & 

World Health Organisation Collaborative 

Program. 

Under the Government of India and World 

Health Organization collaborative program 

on oral health, a Multicentric oral health 

survey was envisaged in the year 2004, in 

order to have a baseline data of the oral 

diseases burden and associated risk profile 

of the population for four index age group 

i.e 12, 15, 35-44 and 65-74 years. This 

survey was conducted in seven different 

geographical locations in India i.e. 

Arunachal Pradesh, Delhi, Maharashtra, 

Puducherry, Rajasthan, Orissa and Uttar 

Pradesh. The loss of attachment (3 mm or 

more) was 77% in 35-44 year age group 

and 96% in 65-74 years olds in 

Maharashtra in the present study. 

Attachment loss of >3mm in 35 -44 years 

was highest in Maharashtra (78%) 

followed by Orissa 68% and Delhi 46%. 

The rest of the centers had the prevalence 

ranging between 15-33%. The prevalence 

of Loss of attachment was significantly 

higher in 65-74 years age group compared 

to 35-44 yrs. group. The highest prevalence 

in 65-74 years group was recorded from 

Maharashtra (96%), followed by Orissa 

(90%), Delhi (85.5%), Rajasthan (75%), 

Uttar Pradesh (68%) and Puducherry 

(55%). Arunachal Pradesh recorded the 

lowest prevalence of 20%. The general 

trend for loss of attachment observed was 

that it was higher in rural than in urban 



Periodontitis in India and Bangladesh 

126 

population and was higher in males 

compared to females. 

Naseem Shah
7
 in her report for the 

National Commission on Macroeconomics 

observed more advanced periodontal 

disease affecting 40%–45% of the 

population of India.  

M Sood
8
 in a field survey in Punjab found 

29.1% having shallow pockets (moderate 

periodontitis) and 12.5% deep pockets 

( 6mm severe periodontitis), assessed by 

WHO recommended methods.  

GPI Singh
9
 did a prevalence study in the 

rural and urban subjects of Ludhiana, 

Punjab. He found that the urban subjects 

had more prevalence of moderate and 

severe periodontitis than rural subjects.   

Jagadeesan
10

did a systematic random 

sampling of rural women in Pondichery. 

The prevalence of moderate periodontitis 

increased with age; there was a risk of 2.3 

times for persons above 35 years to get 

periodontitis. 

Doifode
11

 in a field survey of two 

randomly selected nagars of Nagpur, 

Maharashtra found 34.8% periodontal 

disease.  

Vandana K.L
12

 found 27% periodontitis in 

flourosis affected patients attending 

Periodontics OPD. Prevalence increased 

with age and was significantly more in 

females.   

Helderman
13

 in a review observed the 

prevalence of subjects with deep 

periodontal pockets in Bangladesh was 26 

per cent and it can tentatively be concluded 

that Bangladesh belongs to the 20 per cent 

of countries in the world where periodontal 

conditions of the population are among the 

worst. 

Akhter
14

 found that of the 582 patients 

attending Dhaka Dental College Hospital 

who underwent extractions of their teeth, 

18.5% was due to periodontal reasons. 

Arvidson-Bufano
15

 found shallow pockets 

in 34% of the urban slum group and in 

42% of the rural group, in a survey of 826 

individuals residing in Central and Western 

Bangladesh. 

Table 1: Prevalence data of periodontitis 

Year Author Country 
Sample 

size 
Population  

Age 

range
Prevalence  

1956 
M.K. 

Sanjana
6 India 1445 Urban 16-50 N.A 

1957 Ramfjord
5

India 1677 Urban + Rural
11-17, 

19-30. 
10% at age 17 

1960 Greene
4
  India 802 Urban males 11-17 <2% 

1960 Greene
4
 India 748 Rural males 11-17 <2% 

1960 Greene
4
 India 63 Rural males 18-30 30.2% 

2000 Doifode
11 

India  5061 

Urban, 

Representative

population  

0-60+ 34.8% (31.7M, 32.5F ) 

2000 
M

Jagadeesan
10 India 912  

Field survey, 

rural women 

>15 

years

20.63% Moderate, 25.6% 

(severe periodontitis.) 



Shaju Jacob P 

127 

Year Author Country 
Sample 

size
Population  

Age 

range
Prevalence  

2004 Bali et al
2

India
310 per 

region 

Urban and 

rural 

5,12,35-

44,65-74 

groups 

17.5% moderate &7.8% 

severe periodontitis (35-

44years)

21.4%moderate and 18.1 

severe periodontitis (65-

74years)

2005 M. Sood
8

India 1000 Field survey  N.A 
29.1%Moderate, 

12.5%severe periodontitis. 

2005 GPI Singh
9
  India 1000 Field survey >15years 

39.4%Moderate, 

16.9%severe periodontitis. 

2005 GPI Singh
9
  India 

500 

urban 
Field survey >15years 

43.2%Moderate, 

22.9%severe periodontitis 

2005 GPI Singh
9
  India 

500 

rural 
Field survey >15years 

31.7%Moderate, 

11.0%severe periodontitis. 

2007 
Vandana 

KL
12 India 1029 

Periodontics 

OPD 

15-

74years.
27% (24.2M, 32.8F) 

2007 

WHO
1

Arunachal 

pradesh 

India 3200 Field survey 

12, 15, 

35-44, 

65-74 

age

group. 

15% moderate and 2.6 

severe periodontitis (35-44 

years), 18% moderate and 

0.6% severe periodontitis 

(65-74 years)  

2007 
WHO

1

Delhi
India 3200 Field survey 

12, 15, 

35-44, 

65-74 

age

group. 

34% mod and 1.0% severe 

in 35-44, 1.7% mod and 

1.7% sev in 65-74 age 

groups.  

2007 
WHO

1

Maharashtra 
India 3200 Field survey 

12, 15, 

35-44, 

65-74 

age

group. 

48% moderate and 2.9% 

severe periodontitis (35-44 

years), 55.2% moderate 

and 4.5% severe 

periodontitis (65-74 years)  

2007 
WHO

1

Orissa 
India 3200 Field survey 

12, 15, 

35-44, 

65-74 

age

group. 

35.7% moderate and 9.7% 

severe periodontitis (35-44 

years), 42% moderate and 

15.6% severe periodontitis 

(65-74 years) 

2007 
WHO

1

Puduchery 
India 3200 Field survey 

12, 15, 

35-44, 

65-74 

age

group. 

26.3% moderate and 4.7% 

severe periodontitis ( 35-44 

years)   



Periodontitis in India and Bangladesh 

128 

Year Author Country 
Sample 

size 
Population  

Age 

range
Prevalence  

2007 
WHO

1

Rajasthan
India 3200 Field survey 

12, 15, 

35-44, 

65-74 

age

group. 

48% moderate and 2% 

severe periodontitis (35-44 

years)

2007 
WHO

1
 Uttar 

Pradesh 
India 3200 Field survey 

12, 15, 

35-44, 

65-74 

age

group. 

23.5% moderate 

periodontitis (35-44 years), 

34.5% moderate and 14% 

severe (65-74 years).  

1990 
Arvidson-

Bufano
15 Bangladesh  

Hospital, 

urban slums 
 34% 

1990 
Arvidson-

Bufano
15 Bangladesh  Hospital, rural  42% 

1996 Helderman
13 

Bangladesh  review  26% (severe periodontitis) 

2008 Akhter
14 

Bangladesh 582 Hospital  18.5% 

Discussion

School and hospital population are easy to 

access and study. But they are convenient 

samples which cannot be generalized to the 

target population. There is an increase of 

about 10% between the prevalence in 

general population and hospital based 

population. The early studies
4,5

 were done 

on school population. The school 

population will be a young population and 

only persons affordable to attend the 

schools will be represented. And the school 

population is least representative of the 

periodontitis susceptible population. But if 

young persons show levels of periodontitis 

as seen in Ramfjord
5
 surveys, it is a cause 

for alarm as it reflects a poor hygiene 

status and dental service utilization by the 

population.  

Another limitation observed was the use of 

CPITN as a case definition for 

periodontitis. CPITN is a treatment need 

index to find the prevalence of persons 

requiring treatment. It does not give true 

prevalence in terms of severity and extent.  

Further the prevalence data should 

correlate with tooth loss to find if the 

increased prevalence of periodontitis is 

reflected in increased tooth mortality. This 

will also help us to find at what level of 

severity of periodontitis is tooth loss a 

consequence. Abnormal Probing depth is a 

cause for concern if it leads to increased 

risk for tooth loss and its threshold should 

be identified based on its consequence. Yet 

very little data are available on tooth loss.
7

The WHO Global Oral Health 

Programme
16

 formulated the policies and 

the necessary actions for the improvement 

of oral health. The strategy is that oral 

disease prevention and the promotion of 

oral health needs to be integrated with 

chronic disease prevention and general 

health promotion as the risks to health are 

linked (like tobacco consumption and the 

standard of hygiene). Yet for effective 

integration of oral disease management 

with other chronic diseases, prevalence 

data along with risk due to various factors 

should be available. Oral disease including 

periodontal disease and tooth loss is a 

serious public-health problem. Its impact 

on individuals and communities in terms of 

pain and suffering, impairment of function 



Shaju Jacob P 

129 

and reduced quality of life, is considerable. 

With the growing consumption of tobacco 

in many low and middle income countries, 

the risk of periodontal disease, tooth loss 

and oral-cavity cancer is likely to increase.  

Naseem Shah
7
 in her report for the 

National Commission on Macroeconomics 

and Health (NCMH) observed that for 

periodontal diseases the projection is 

alarming with prevalence at present being 

45% for 15+ years, and the actual 

prevalence in lakhs will be 2957.6 (year 

2000), 3190.2(year 2005), 3413.8(year 

2010) and 3624.8(year 2015). Due to the 

rampant use of paan masala and gutka by 

persons of all age groups and both the 

sexes’ periodontal disease prevalence will 

increase than projected. If minor 

periodontal diseases are included, the 

proportion of population above the age of 

15 years with this disease could be 80%–

90%. Concerned
11

 with the urgent need for 

action in promoting sound oral health, 

prevention of dental caries and periodontal 

diseases and to give impetus to activities to 

promote oral health, WHO had dedicated 

World Health Day 1994 to oral health.  

Conclusion

There is a lack of prevalence data of the 

Indian and Bangladesh population. Case 

definitions have to be formed with the 

local population in mind. As Bangladesh 

and India share more in common, a 

common approach can be developed to 

study periodontal diseases with the 

subcontinent’s uniqueness in mind. This 

will help us utilizing the scarce resources 

available to combat and prevent 

periodontitis and its related tooth loss.  

______________ 



Periodontitis in India and Bangladesh 

130 

Reference

1. Naseem Shah, Pandey R.M. et al,., Oral Health 

in India: A report of the multi centric study, 

Directorate General of Health Services, 

Ministry of Health and Family Welfare, 

Government of India & World Health 

Organisation Collaborative Program, 

December 2007. 

2. Bali, Mathur, Talwar, Chanana. National Oral 

Health Survey and Flouride Mapping 2002-

2003. India. Dental Council of India, New 

Delhi, 2004. 

3. Albandar & Rams. Global epidemiology of 

periodontal diseases: an overview. 

Periodontology 2000 2002; 29:7-10. 

4. Greene. J.C.  Periodontal Disease in India: 

Report of an Epidemiological Study. Journal of 

Dental Research 1960; 39:302-312. 

5. Ramfjord.S.P, Emslie, Greene J.C, Held and 

Waerhaug.J. Epidemiological Studies Of 

Periodontal Diseases. American Journal of 

Public Health 1968; 58(9):17-22. 

6. Sanjana M.K., Mehta F.S., Doctor R.H.  and 

Baretto M.A. Mouth Hygiene Habits and Their 

Relation To Periodontal Disease Journal of 

Dental Research 1956; 35:645-47. 

7. Naseem Shah. Oral and dental diseases: 

Causes, prevention and treatment strategies In 

NCMH Background Papers—Burden of 

Disease in India (New Delhi, India), September 

2005, National Commission on 

Macroeconomics and Health, Ministry of 

Health & Family Welfare, Government of 

India, New Delhi September 2005, 275-298 

8. Sood M. A Study of Epidemiological Factors 

Influencing Periodontal Diseases in selected 

Areas of District Ludhiana, Punjab. Indian 

Journal of Community Medicine 2005; 

30(2):70-71. 

9. Singh GPI, Bindra J, Soni. Prevalence of 

Periodontal diseases in urban and rural areas of 

Ludhiana, Punjab. Indian Journal of 

Community Medicine 2005; 30(4):128-9 

10. Jagadeesan M, Rotti SB, Dananbalan M. Oral 

Health status and risk factors for dental and 

periodontal diseases among rural women in 

Pondicherry. Indian Journal of Community 

Medicine 2000; XXV(1):31-38 

11. Doifode VV, Ambadekar NN, Lanewar AG. 

Assessment of oral health status and its 

association with some epidemiological factors 

in population of Nagpur, India. Indian J Med 

Sci. 2000; 54(7):261-9 

12. Vandana KL, Reddy SM, Assessment of 

periodontal status in dental fluorosis subjects 

using community periodontal index of 

treatment needs. Indian Journal of Dental 

Research 2007; 18:67-71 

13. Van Palenstein Helderman WH, Joarder MA, 

Begum A. Prevalence and severity of 

periodontal diseases and dental caries in 

Bangladesh. Int Dent J. 1996 Apr;46(2):76-81. 

14. Akhter R, Hassan NM, Aida J, Zaman KU, 

Morita M. Risk indicators for tooth loss due to 

caries and periodontal disease in recipients of 

free dental treatment in an adult population in 

Bangladesh. Oral Health Prev Dent. 

2008;6(3):199-207. 

15. Arvidson-Bufano UB, Holm AK. Dental health 

in urban and rural areas of central and western 

Bangladesh. Odontostomatol Trop. 1990 

Sep;13(3):81-6. 

16. Poul Erik Petersen, World Health 

Organization,Geneva, Switzerland. World 

Health Organization global policy for 

improvement of oral health – World Health 

Assembly 2007. International Dental Journal 

2008; 58:115-121. 

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