752+2024 Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs: A Cross-SecConal Study Vol 12 No 2 (2024) DOI 10.5195/d3000.2024.752 h#p://den*stry3000.pi#.edu Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs: A Cross-Sectional Study Rusul Subhi Hassan, Zanbaq Azeez Hanoon, Salah M. Ibrahim*, Nabaa Basim Alhusseini Faculty of Dentistry, Kufa University, Najaf, Iraq *Corresponding Author Abstract Objec>ve: This cross-sec4onal study aimed to assess the periodontal status and treatment needs of undergraduate dental students at Al-Kufa University in Iraq and inves4gated the influence of demographic factors (age and gender) and oral hygiene prac4ces (tooth brushing technique, frequency of brushing, use of interdental aids, dental visit paDerns) on periodontal health. Materials and Methods: A sample of 200 undergraduate dental students (aged 18-24 years) was selected using a mul4stage systema4c random sampling procedure during the 2023-2024 academic year. Periodontal health was assessed using the World Health Organiza4on Community Periodontal Index for Treatment Needs (CPITN). The CPITN probe was used to evaluate bleeding on probing, presence of calculus, plaque reten4ve factors, and pocket depths (4, 5, and 6 mm). Data were analyzed using SPSS version 23, and the Pearson’s chi-square test was used to assess associa4ons, with a p-value ≤ 0.05 considered sta4s4cally significant. Results: The study revealed a high prevalence of periodontal disease (86.5%) among the students. Calculus was the most frequent finding (65.5%), while only 13.5% of students exhibited a healthy periodon4um. The majority (69%) required scaling and root planning (TN2). Female students exhibited significantly healthier periodon4a compared to males (p<0.05). Older students (21-24 years) had a significantly higher prevalence of deeper periodontal pockets than younger students (p<0.05). Smoking was significantly associated with poorer periodontal health (p<0.05). A sta4s4cally significant associa4on was found between the frequency of tooth brushing and periodontal health (p<0.05), with those brushing twice daily showing beDer periodontal status. While not sta4s4cally significant, the use of interdental aids was associated with healthier periodon4a. Students with irregular dental visit paDerns had a higher prevalence of calculus (p<0.05). Conclusion: This study found a high prevalence of periodontal disease and significant treatment needs among undergraduate dental students at Al-Kufa University. Gender, age, smoking status, and oral hygiene prac4ces were associated with periodontal health. These findings emphasize the urgent need for comprehensive oral health educa4on programs, incorpora4ng behavioral change strategies and promo4ng the importance of preven4ve dental care. Keywords: AL- Kufa University, Periodontal Disease, Cross-Sec4onal Study, Dental Student, Community Periodontal Index for Treatment Needs Cita:on: Hassan RS, et al. (2024) Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs: A Cross-Sec:onal Study. Den:stry 3000. 2:a001 doi:10.5195/d3000.2024.752 Received: October 20, 2024 Accepted: November 1, 2024 Published: November 22, 2024 Copyright: ©2024 Hassan RS, et al. This is an open access ar:cle licensed under a Crea:ve Commons AVribu:on Work 4.0 United States License. Email: Salahm.abrahem@uokufa.edu.iq Introduction Periodontal diseases (PDs) are one of most ubiquitous and major dental diseases among the human populations worldwide [1]. PDs, comprising gingivitis and periodontitis, are probably the most common disease of mankind. These diseases are considered as the main cause of tooth loss among adult populations. No nation or region of the world is free from this pathological disease [1,2]. Gram-negative anaerobic bacteria found in dental biofilm are linked to the chronic Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu inflammatory diseases known as PDs, which cause irreversible damage to the periodontium. Dental plaque that has accumulated and not been removed is a major factor in the development and course of disease [2,3]. Dental plaque is defined clinically as a structured, resilient, yellow-grayish substance that adheres tenaciously to the intraoral hard surfaces, including removable and fixed restorations in the absence of proper oral hygiene practices. Plaque is classified as a type of biofilm, which is characterized as microbial populations embedded in a matrix and adhering to surfaces, interfaces, or other objects [4]. The biofilm nature of dental plaque means that it tenaciously adheres to surfaces which increase in complexity and pathogenicity with time [5]. PDs can be regarded as a host-microbial interaction in which the transition from health to disease can be brought about by the balance between host and bacterial factors. The result of this interaction is influenced by both bacterial and host factors. The balance could be upset, for example, by a rise in bacterial virulence, a decrease in host resistance, or an increase in plaque biofilm. Local, systemic, and/or other factors further alter periodontal disease's clinical presentation [6]. Due to a shortage of oral health professionals in many developing nations, services are typically provided by neighborhood or focal emergency clinics in urban areas, with preventive dental care receiving little weight [1]. To assess the condition of periodontal health, the World Health Organization's (WHO) Oral Health Unit and Federation Dentaire International (FDI) collaborated to develop the community periodontal index for treatment needs (CPITN). It is a quick and easy way to determine a population group's treatment needs (TNs) and has served as the primary indicator in some epidemiological studies on the prevalence of periodontal disease, it [7,8]. In the adult population, the most severe PD code (CPITN code 4) ranges from 10% to 15% globally. While oral health has generally gotten worse in developing nations, it has significantly improved in industrialized nations. The WHO Oral Data Bank has noted and documented these patterns and trends. Populations in these countries are becoming more and more afflicted with PDs, periodontal infections, and compromised masticatory functions [9-12]. There is currently no available epidemiological data on the state of periodontal health in the governorate of AL-Najaf, Iraq, from either the general population or the dental students at AL-Kufa University. This investigation was conducted among a sample of AL- Kufa University dental students for the reasons previously mentioned. Materials and Methods Study Design and Se5ng This research employed an observa`onal, analy`cal, cross- sec`onal study design to inves`gate the periodontal health status and treatment needs of undergraduate dental students [13]. The study was conducted at the Department of Periodon`cs, College of Den`stry, Al-Kufa University, located in Najaf, Iraq. Data collec`on was carried out during the academic year 2023– 2024. The cross-sec`onal design allowed for a snapshot of the periodontal health of this specific popula`on at a par`cular point in `me. Ethical Considera8ons Before commencing the study, ethical approval was obtained from the Ethical Commidee of the College of Medicine, University of Kufa (reference # MEC-36, Date: 14/5/2024). The study adhered to the ethical principles outlined in the Declara`on of Helsinki [14]. All par`cipants received a detailed explana`on of the study's purpose, procedures, risks, and benefits. Wriden informed consent was obtained from each student prior to their par`cipa`on, ensuring Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu their voluntary involvement and understanding of the study's implica`ons. Study Subjects and Sampling Methodology The target popula`on for this study comprised all undergraduate dental students (N = 741) enrolled at Al-Kufa University during the study period. To ensure a representa`ve and manageable sample, a mul`stage systema`c random sampling procedure was implemented [15]. The student popula`on was ini`ally divided into five strata based on their academic year (first year through fiih year). Stra`fica`on aimed to ensure propor`onal representa`on of students from each year of the dental program, minimizing poten`al bias due to differences in clinical experience or exposure to periodontal educa`on. Within each stratum, 40 students were randomly selected using a systema`c random sampling technique [16]. This technique involved: Determina)on of the Sampling Interval. The sampling interval (k) was calculated by dividing the total number of students in each stratum by the desired sample size for that stratum (40 students). Random Star)ng Point. A random number between 1 and k was selected as the star`ng point. Systema)c Selec)on. Every kth student on the list, star`ng from the randomly selected star`ng point, was chosen un`l 40 students were selected from that stratum. This mul`stage sampling procedure ensured a representa`ve sample of undergraduate dental students from all academic years, minimizing sampling bias and enhancing the generalizability of the findings to the broader student popula`on. Inclusion Criteria Ac)ve Enrollment. Par`cipants had to be ac`vely enrolled as undergraduate dental students at Al-Kufa University's College of Den`stry. Age Range. Students were required to be between 18 and 24 years of age. This age range targeted the typical student popula`on in dental schools. Exclusion Criteria Age Outside Range. Students younger than 18 or older than 24 were excluded to ensure a consistent age group. Non-Par)cipa)on. Students who declined to par`cipate were excluded to respect their autonomy and ensure voluntary par`cipa`on. Orthodon)c Treatment. Students undergoing orthodon`c treatment were excluded because orthodon`c appliances could influence periodontal health and confound the study results. Dental Implants. Individuals with dental implants were excluded, as implants require different periodontal assessment techniques and could impact the study findings. Medical Condi)ons. Students with medical condi`ons that could restrict periodontal examina`on or affect periodontal health were excluded. These condi`ons included, but were not limited to, HIV/AIDS, diabetes mellitus, and individuals undergoing long-term medica`on use. Data Collec8on Procedures Data were collected through two primary methods: a self- administered ques`onnaire and a standardized clinical periodontal examina`on. Ques)onnaire. A structured ques`onnaire was used to gather informa`on on the following: Demographic Data. Age and gender were collected to describe the study sample and explore poten`al associa`ons with periodontal health. Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu Dental Health-Related Prac)ces. The following variables were included: - Tooth Brushing Frequency. Students were asked about how oien they brushed their teeth, with op`ons including once daily, twice daily, more than twice daily, and other (specifying their frequency). - Tooth Brushing Technique. Students indicated their usual tooth brushing technique from the following op`ons: horizontal, ver`cal, scrubbing, circular, or other (specifying their technique). - Use of Interdental Aids. Par`cipants indicated whether they used dental floss, toothpicks, interdental brushes, or other interdental cleaning aids (specifying the type). - Frequency of Dental Visits. Op`ons included regular checkups, irregular visits, visits only for emergencies, or never visi`ng a den`st. - Reason for Dental Visits. Students selected their primary reason for visi`ng the den`st as preven`ve (for checkups and cleanings), cura`ve (for treatment of dental problems), or other (specifying the reason). The ques`onnaire was designed to be self-administered, allowing students to complete it at their own pace and ensuring privacy in their responses. Clear instruc`ons were provided, and any ques`ons from students were addressed before they began comple`ng the ques`onnaire. Clinical Periodontal Examina)on. A standardized clinical periodontal examina`on was conducted on each par`cipant to assess their periodontal health status. The examina`on was performed by a single calibrated examiner to ensure consistency and minimize inter-examiner variability [17]. The following procedures were followed: - Prepara`on. The examiner used gloves and a mask for infec`on control. A disposable mouth mirror and a sterile CPITN-E probe were used for each par`cipant as shown in Figures 1 and 2. The CPITN-E probe is specifically designed for use with the CPITN index and has a 0.5 mm ball `p and color-coded markings at 3.5 mm and 5.5 mm to facilitate pocket depth measurements. - Examina`on Protocol. The examina`on adhered to the World Health Organiza`on (WHO) guidelines for using the Community Periodontal Index for Treatment Needs (CPITN) [12]. The following steps were followed: - Mouth Division. The mouth was systema`cally divided into six sextants: upper right, upper lei, lower right, lower lei, upper anterior, and lower anterior. - Sextant Assessment. Each sextant was examined to ensure the presence of at least two teeth, excluding third molars unless they served as a replacement for a missing second molar. If a sextant had less than two teeth, it was recorded as Code X (missing sextant). - Index Teeth Selec`on. For each sextant with two or more teeth, specific index teeth were examined. The index teeth selected were based on the par`cipant's age: - For students 20 years and older. 17, 16, 11, 26, 27, 36, 37, 31, 46, and 47. - For students 19 years and younger. 16, 11, 26, 36, 31, and 46. - Probing Technique. The index teeth were probed at the mesial, midline, and distal loca`ons on both the facial (labial/buccal) and lingual (palatal) surfaces. Gentle probing pressure was applied, inser`ng the probe into the gingival sulcus or periodontal pocket un`l resistance was felt [18]. - Parameter Assessment. The following parameters were evaluated for each index tooth: - Bleeding on Probing (BOP). The presence of bleeding within 30-60 seconds aier probing. BOP Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu is an early indicator of gingival inflamma`on. - Calculus. The presence of detectable calculus using the probe. Calculus, a hardened form of plaque, is a significant contributor to periodontal disease. - Plaque Reten`ve Factors. The presence of any factors that could contribute to the accumula`on of plaque, such as overhanging restora`ons, poorly fipng crowns, or anatomical grooves. These factors make plaque removal more difficult and can exacerbate periodontal disease. - Pocket Depths. The depth of the gingival sulcus or periodontal pocket, measured in millimeters, was recorded for each probing site using the CPITN-E probe. The probe's markings at 3.5 mm and 5.5 mm helped to iden`fy pockets exceeding 4 mm and 6 mm, respec`vely. - CPITN Code Recording. The highest CPITN code observed for each sextant was recorded. This method of recording ensures that the most severe periodontal finding within each sextant is captured. CPITN Codes and Treatment Needs. The Community Periodontal Index for Treatment Needs (CPITN) u`lizes a simplified coding system to classify periodontal health status and guide treatment decisions [19]. The CPITN codes and their corresponding treatment needs are as follows: Code 0: Healthy Periodon`um. This code indicates a healthy periodon`um with no signs of inflamma`on, calculus, or pocke`ng. No treatment is needed (TN0). Code 1: Bleeding on Probing. This code signifies gingival inflamma`on, even in the absence of calculus or pocke`ng. The recommended treatment (TN1) is oral hygiene instruc`on, emphasizing proper brushing and interdental cleaning techniques to control plaque accumula`on. Code 2: Calculus Present. This code indicates the presence of calculus, which can irritate the gums and contribute to periodontal disease progression. The recommended treatment (TN2) is scaling and root planing to remove the calculus and smooth the root surfaces, promo`ng healing and reducing inflamma`on. Code 3: Pockets 4-5 mm Deep. This code signifies a moderate level of periodontal disease, characterized by deeper pockets where plaque and calculus can accumulate more easily. The recommended treatment (TN2) is scaling and root planing, like Code 2. Code 4: Pockets 6 mm or Deeper. This code indicates a more advanced stage of periodontal disease, with deep pockets that are difficult to clean and pose a significant risk of tooth loss. The recommended treatment (TN3) is complex periodontal treatment, which may involve surgical procedures, advanced cleaning techniques, and long-term maintenance. Sta8s8cal Analysis Data collected from the ques`onnaires and clinical examina`ons were entered and analyzed using IBM SPSS Sta`s`cs for Windows, Version 23.0 (IBM Corp., Armonk, NY). Descrip`ve sta`s`cs were used to summarize data, including frequencies and percentages for categorical variables such as gender, smoking status, tooth brushing technique, frequency of tooth brushing, use of interdental aids, frequency of dental visits, and reasons for dental visits. For the con`nuous variable age, the mean, standard devia`on, minimum, and maximum were calculated. Pearson chi-square (χ2) test was employed to examine associa`ons between the highest CPITN code recorded for each student and the categorical Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu variables. This test was used to determine if there was a sta`s`cally significant frequency differences between periodontal health status and these poten`al risk factors. A p-value (P) of ≤ 0.05 was considered sta`s`cally significant, indica`ng a less than 5% probability that the observed associa`on between the variables was due to random chance. Figure 1. Instruments, equipment and materials used in the study. Figure 2. The CPITN-E probe. Results Periodontal Health Status and Treatment Needs Table 1 and Figure 3 display the findings of the clinical periodontal examination, which involved evaluating the periodontal health status using CPITN. The results showed that 13.5% of students had a healthy periodontium, 17.5% had bleeding on probing, and 65.5% of them had calculus. Additionally, 3.5% and none of students, respectively, had pocket depths of 4-5 mm and 6 mm or more. Table 1. Distribu`on of students according to result of periodontal health status using CPITN. No. CPTIN Number Percentage % 1 Healthy periodon`um 27 13.5% 2 Bleeding 35 17.5% 3 Calculus 131 65.5% 4 Pocket depth 4-5mm 7 3.5% 5 Pocket depth 6mm or more 0 0% Total 200 100% Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu 13.5 17.5 65.5 3.5 0 0 10 20 30 40 50 60 70 1 2 3 4 5 Figure 3. Percentages of Periodontal Health Status in the sample. About type of treatment that each student included in the study needs is described in Table 2 and Figure 4. Most students (69%) required professional interven`on, as indicated by TN2. Table 2. Distribu`on of students according to their treatment needs using CPITN. Treatment needs Number Percentage % TN0 27 13.5% TN1 35 17.5% TN2 138 69% TN3 0 0% Total 200 100% Figure 4. Distribu`on of students by CPITN Treatment Needs. Associa8on between categorical variables with highest CPITN codes The associa`on between age, gender, smoking, with highest codes of CPITN were tested sta`cally using chi square (X2). Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu Age: The percentage of students in the 18–20 age group had a higher percentage of healthy periodontium (9%) and a lower percentage of other codes. In the 21–24 age group, the deep pocket had the highest percentage, which was 2%. The associa`on between age and highest CPITN codes was sta`s`cally significant (P<0.05), as shown in Table 3. Table 3. Distribu`on of students according to result of periodontal health status using CPITN by age. Age (21-24) No. (%) Age (18-20) No. (%) CPTIN 9 (4.5) 18 (9) Healthy periodon`um 22 (11) 13 (6.5) Bleeding 99 (49.5) 32 (16) Calculus 4 (2) 3 (1.5) Pocket depth 4-5mm 0 0 (0) Pocket depth 6mm or more 134 (67) 66 (33) Total X2= 36.98 Degree of freedom (DF) =4 (P<0.05) (S) Gender: Compared to male students, female students had a higher percentage of healthy periodontium (9%). Table 4 indicates that these associations were statistically significant (P<0.05). Table 4. Sta`s`cal analysis and distribu`on of students according to their highest CPITN codes by gender. Students Gender CPTIN Male No. (%) Female No. (%) 9 (4.5) 18 (9) Healthy periodon`um 21 (10.5) 14 (7) Bleeding 90 (45) 41 (20.5) Calculus 1 (0.5) 6 (3) Pocket depth 4-5mm 0 0 (0) Pocket depth 6mm or more 121 (60.5) 79 (39.5) Total X2= 18 Degree of freedom (DF) =4 (P<0.05) (S) Smoking: Students who did not smoke had healthier periodontium (12.5%) than students who smoked, who are more likely to have calculus (57%), and to have a pocket depth of 4-5 mm (3.5%). Smoking and the highest CPITN codes were statistically significantly associated (P<0.05), as shown in Table 5. Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu Table 5. Sta`s`cal analysis and distribu`on of students according to their highest CPITN codes by smoking status. Smoking CPTIN Smoker No. (%) Non-Smoker No. (%) 2 (1) 25 (12.5) Healthy periodon`um 28 (14) 7 (3.5) Bleeding 114 (57) 17 (8.5) Calculus 7 (3.5) 0 (0) Pocket depth 4-5mm 0 0 (0) Pocket depth 6mm or more 151 (75.5) 49 (24.5) Total X2= 109.52 Degree of freedom (DF) =4 (P<0.05) (S) Associa8on between age and gender with Periodontal TNs of CPITN The associa`ons between age and gender with TNs were tested sta`s`cally using X2. Age: The highest percentage of students with TN0 was reported among 18- 20 years age group (9%). TN2 was recorded more oien among 21- 24 years old. These associa`ons were sta`s`cally significant (P<0.05), as shown in Table 6. Table 6. Sta`s`cal analysis and distribu`on of students according to their periodontal TNs by age. Age (21-24) No. (%) Age (18-20) No. (%) TNs 9 (4.5) 18 (9) TN0 22 (11) 13 (6.5) TN1 103 (51.5) 35 (17.5) TN2 0 (0) 0 (0) TN3 134 (67) 66 (33) Total X2= 32.305 DF=3 P<0.05(S) Gender: No need for treatment (TN0) was higher among female students (9%). While for TN2, the higher percentage (45.5%) was recorded among male students. These associa`ons were sta`s`cally significant (P<0.05), as shown in Table 7. Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu Table 7. Sta`s`cal analysis and distribu`on of students according to their periodontal TNs by gender. Students Gender TNs Male No. (%) Female No. (%) 9 (4.5) 18 (9) TN0 21 (10.5) 14 (7) TN1 91 (45.5) 47 (23.5) TN2 0 (0) 0 (0) TN3 121 (60.5) 79 (39.5) Total X2 =9.828 DF=3 P<0.05(S) Dental health-related prac8ces and paHern of visits to dental clinic Tables 8 and 9 show the numbers and percentages of dental health-related prac`ces, in which 97.5% of the study students reported to have prac`ced teeth cleaning regardless of the method of teeth cleaning. Regarding method of teeth brushing, most students (36.41%) prac`ced scrubbing method for teeth cleaning. About frequency of teeth cleaning, the greater part of students cleaned their teeth twice and once daily (50.25% and 30.25%), respec`vely. Using of interdental aids was reported in 45.5 % of the students. Out of them, 84.61% were using dental floss, 43.95% were using toothpick, and 3.29% were using interdental brush. Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu Table 8. Sta`s`cal analysis and distribu`on of students according to their highest CPITN codes by method and frequency of teeth brushing. CPITN Teeth cleaning Yes (%) No (%) Healthy periodontium 31 (15.5) 0 Bleeding 30 (15) 2 (1) Calculus 129 (64.5) 1 (0.5) Pocket depth 4-5 mm 5 (2.5) 2 (1) Pocket depth 6 mm or more 0 0 Total 195 (97.5) 5 (2.5) X2= 180.5 Degree of freedom (DF) =4 (P<0.05) (S) CPITN Method of teeth brushing Horizontal N (%) Vertical N (%) Scrubbing N (%) Circular N (%) Healthy periodontium 4 (2.05) 5 (2.56) 8 (4.1) 9 (4.61) Bleeding 4 (2.05) 15 (7.69) 14 (7.17) 7 (3.58) Calculus 12 (6.15) 39 (20) 46 (23.59) 27 (13.84) Pocket depth 4-5 mm 1(0.51) 1 (0.51) 3 (1.53) 0 Pocket depth 6 mm or more 0 0 0 0 Total 21 (10.76) 60 (30.76) 71 (36.41) 43 (22.05) X2= 31.9 Degree of freedom (DF) =12 (P<0.05) (S) CPITN Frequency of teeth brushing Once (%) Twice (%) More (%) Occasional (%) Healthy periodontium 7 (3.59) 13 (6.67) 4 (2.05) 4 (2.05) Bleeding 7 (3.59) 11 (5.64) 7 (3.59) 2 (1.02) Calculus 40 (20.51) 74 (37.94) 15 (7.69) 6 (3.07) Pocket depth 4-5 mm 5 (2.56) 0 0 0 Pocket depth 6 mm or more 0 0 0 0 Total 59 (30.25) 98 (50.25) 26 (13.33) 12 (6.15) X2= 96.91 Degree of freedom (DF) =12 (P<0.05) (S) Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu Table 9. Sta`s`cal analysis and distribu`on of students according to their highest CPITN codes by use type of interdental aid. CPITN Use of interdental aids Yes (%) No (%) Healthy periodontium 16 (8) 8 (4) Bleeding 23 (11.5) 17 (8.5) Calculus 50 (25) 79 (39.5) Pocket depth 4-5 mm 2 (1) 5 (2.5) Pocket depth 6 mm or more 0 0 91(45.5) 109(54.5) X2= 8 Degree of freedom (DF) =4 (P>0.05) (NS) CPITN Type of interdental aid Dental floss (%) Toothpick (%) Interdental brush (%) Healthy periodontium 10 (10.98) 14 (15.38) 1 (1.09) Bleeding 6 (6.59) 10 (10.98) 2 (2.19) Calculus 50 (54.9) 16 (17.58) 0 Pocket depth 4-5 mm 11 (12.08) 0 0 Pocket depth 6 mm or more 0 0 0 Total 77 (84.61) 40 (43.95) 3 (3.29) X2= 68.44 Degree of freedom (DF) =8 (P<0.05) (S) Frequency of visits to the dentist. Most of the dental students visited the den`st irregularly (49.5%). The highest percentage of calculus was reported among dental students who visited the dental clinic irregularly (27.5%). The associa`ons between highest CPITN codes and frequency of visits to the dentist was sta`s`cally significant different (P<0.05), as shown in Table 10. Reason for dental visit. The highest percentage adended the dental clinic for cura`ve reason (77.5%), while calculus was higher in the cura`ve group (51%) and the associa`on was sta`s`cally significant (P<0.05), as shown in Table 10. Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu Table 10. Sta`s`cal analysis and distribu`on of dental students according to their highest CPITN codes by paderns of visits to dental clinic. Frequency of visits to dentist on emergency (%) Never (%) Irregular (%) Regular (%) CPITN 2 (1) 5 (2.5) 19 (9.5) 7 (3.5) Healthy periodontium 0 0 21 (10.5) 9 (4.5) Bleeding 39 (19.5) 21 (10.5) 55 (27.5) 16 (8) Calculus 0 2 (1) 4 (2) 0 Pocket depth 4-5 mm 0 0 0 0 Pocket depth 6 mm or more 41 (20.5) 28 (14) 99 (49.5) 32 (16) Total X2= 65.8 Degree of freedom (DF) =12 (P<0.05) (S) Reasons for visit Preventive (%) Curative (%) CPITN 6 (3) 20 (10) Healthy periodontium 4 (20) 27 (13.5) Bleeding 30 (15) 102 (51) Calculus 5(2.5) 6 (3) Pocket depth 4-5 mm 0 0 Pocket depth 6 mm or more 45(22.5) 155 (77.5) Total X2= 60.5 Degree of freedom (DF) =4 (P<0.05) (S) Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu Discussion This study unveiled a concerning periodontal health landscape among undergraduate dental students at Al-Kufa University. The high prevalence of periodontal disease, the significant need for treatment, and the associa`ons with various factors underscore the urgency of addressing oral health challenges within this future genera`on of dental professionals. A High Prevalence of Periodontal Diseases: A Global Concern Mirrored Locally Our study revealed that a staggering 86.5% of dental students exhibited signs of periodontal disease. This finding aligns with global trends, as periodontal diseases are among the most prevalent chronic condi`ons worldwide, affec`ng a substan`al propor`on of adults [1,2]. However, the prevalence found in our study is even higher than some reports from other regions. For instance, a study conducted on dental and medical students at the Medical University of Bialystok in Poland reported a prevalence rate of 75.38% [12], while a study in Iraq on both dental and non-dental students found a prevalence of 59.23% [13]. These varia`ons in prevalence rates could be adributed to differences in study popula`ons, methodology, or cultural factors influencing oral hygiene prac`ces and access to care. Calculus: A Red Flag for Inadequate Plaque Control The high prevalence of calculus (65.5%) among the students is a significant finding. Calculus, a hardened form of plaque, is a major contributor to periodontal disease development and progression [22]. Its presence indicates a lack of effec`ve plaque control, sugges`ng a need for improved oral hygiene prac`ces and poten`ally a lack of awareness regarding the importance of regular professional dental cleanings. Treatment Needs: Scaling and Root Planing Emerge as a Priority Most students (69%) required scaling and root planing (TN2), indica`ng a substan`al burden of untreated periodontal disease. Scaling and root planing are essen`al procedures for removing plaque and calculus from below the gum line, smoothing the root surfaces, and promo`ng healing [23]. The high percentage of students requiring TN2 underscores the importance of accessible and affordable dental care services within the university sepng. Unveiling the Influences: Age, Gender, and Smoking Our study inves`gated several factors that could influence periodontal health, revealing important associa`ons. Age, a Cumula8ve Impact Factor. As an`cipated, older students (21-24 years) exhibited a higher prevalence of deeper periodontal pockets compared to younger students, sugges`ng that the dura`on of exposure to periodontal risk factors plays a role [20]. Even in this rela`vely young popula`on, prolonged exposure to plaque, inadequate oral hygiene, and other factors led to a worsening of periodontal health. This highlights the importance of establishing healthy oral hygiene habits early in life and maintaining them throughout adulthood. Gender, a Disparity Requiring Further Explora8on. The significant difference in periodontal health between genders, with female students exhibi`ng healthier periodon`a, aligns with previous research [14,21,22]. This difference could be adributed to a complex interplay of factors, including poten`ally beder oral hygiene prac`ces among females [23], varia`ons in hormonal influences on periodontal `ssues [24], or even differences in aptudes towards oral health and aesthe`cs Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu [25]. Further research is needed to disentangle these factors and develop gender-specific interven`ons to address the observed disparity. Smoking, A Well-Established Risk Factor. The detrimental effects of smoking on periodontal health are well-documented [26]. Our study reinforced this associa`on, with smokers exhibi`ng significantly poorer periodontal status compared to non-smokers. Smoking compromises the immune system, impairs blood flow to the gums, and alters the oral microbiome, crea`ng a favorable environment for periodontal pathogens [27]. This finding underscores the cri`cal need to integrate smoking cessa`on programs into the dental school curriculum and educate students about the specific risks smoking poses to periodontal health. Empowering Through Oral Hygiene Prac8ces Our findings strongly support the cri`cal role of effec`ve oral hygiene prac`ces in maintaining periodontal health [28]. Students who brushed their teeth twice daily exhibited significantly beder periodontal status, highligh`ng the importance of consistent and thorough plaque removal through proper brushing techniques [29]. While the use of interdental aids did not reach sta`s`cal significance in our study, the trend towards healthier periodon`a among those who used these aids suggests a poten`al benefit. Interdental cleaning, using dental floss, toothpicks, or interdental brushes, can effec`vely remove plaque from areas that toothbrushes cannot reach, contribu`ng to beder overall periodontal health [30,31]. Emphasizing Preventa8ve Dental Care Our study underscored the vital role of regular dental care in preven`ng and managing periodontal disease. Students who visited the den`st irregularly had a significantly higher prevalence of calculus, emphasizing the importance of professional cleanings to remove plaque and calculus that cannot be adequately addressed through home care alone [32]. Moreover, the higher prevalence of calculus among students who primarily sought cura`ve dental care highlights the need to shii the focus toward preven`ve care. Encouraging regular dental checkups, even in the absence of symptoms, allows for early detec`on and treatment of periodontal issues, preven`ng disease progression and poten`ally more invasive interven`ons. Implica8ons for Al-Kufa University The findings of this study provide a clear roadmap for addressing the periodontal health challenges faced by dental students at Al-Kufa University. • Comprehensive Oral Health Educa8on: The dental school curriculum should integrate comprehensive oral health educa`on programs that go beyond tradi`onal lectures and textbooks. These programs should incorporate interac`ve learning methods, behavioral change strategies, and hands-on demonstra`ons to effec`vely engage students and empower them to adopt healthy oral hygiene prac`ces [33,34]. • Promote Preventa8ve Care: The university should priori`ze preventa`ve dental care through educa`onal campaigns, peer-to-peer support groups, and incen`ves for regular checkups. Collabora`ng with local dental providers to offer discounted or subsidized dental services to students can further encourage early interven`on and preven`on [35,36]. Assessment of Periodontal Health Status and Treatment Needs Among Dental Students of Al-Kufa University by Using the Community Periodontal Index for Treatment Needs. A Cross-SecConal Study h#p://den*stry3000.pi#.edu • Accessible and Affordable Dental Care: Establishing an on-campus dental clinic could significantly improve access to care for students, providing convenient and affordable services. Alterna`vely, the university could explore partnerships with local dental clinics to offer discounted services or develop financial assistance programs to help students cover the cost of dental care [37,38]. Study Limita8ons This study was limited by its single- center design, poten`ally limi`ng the generalizability of findings to other dental schools in Iraq. The cross-sec`onal design, while providing a snapshot of periodontal health, cannot establish cause-and-effect rela`onships, and longitudinal studies are needed to assess changes over `me. Reliance on self-reported data regarding oral hygiene prac`ces and dental visit paderns may be subject to recall or social desirability bias, highligh`ng the need for more objec`ve measures in future research. Finally, the study's focus on a selected set of factors means that other poten`ally influen`al factors, such as diet, stress, and gene`c predisposi`ons, warrant further inves`ga`on. Conclusion The high prevalence of periodontal disease among dental students at Al-Kufa University is a call to ac`on. This study emphasizes the urgent need for a mul`-faceted approach to improve oral health within this popula`on. By integra`ng comprehensive oral hygiene educa`on, promo`ng preventa`ve care, and enhancing access to affordable dental services, Al-Kufa University can equip its future dental professionals with the knowledge, skills, and resources they need to achieve and maintain op`mal oral health, sepng a posi`ve example for their pa`ents and contribu`ng to a healthier community. Availability of data and material: Data are available on request to the corresponding author. Financial support and sponsorship: None. Conflicts of interest: There are no conflicts of interest. References 1. Jebur, H. J., & Ahmed, M. A. A. (2020). Prevalence of periodontal diseases among universi`es students in Al-Basrah governorate, Iraq-a cross- sec`onal study. 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