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ORIGINAL RESEARCH ARTICLE
Year : 2016  |  Volume : 8  |  Issue : 5  |  Page : 119-121  

Evaluation of oral and periodontal status of leprosy patients in Dindigul district


1 Department of Periodontics, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India
2 Department of Periodontics, Chettinad Dental College, Kelambakkam, Tamil Nadu, India
3 Department of Public Health Dentistry, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu, India

Date of Submission06-Apr-2016
Date of Decision28-Apr-2016
Date of Acceptance06-May-2016
Date of Web Publication12-Oct-2016

Correspondence Address:
Dr. S A Jacob Raja
Department of Periodontics, Rajas Dental College and Hospital, Tirunelveli, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-7406.191939

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   Abstract 

Aim: After the introduction of the multidrug therapy, the incidence of leprosy is decreasing every year. However, periodontal complaints are commonly seen in these patients due to compromised immunity and impaired oral hygiene. The aim of the present study is to assess the oral and periodontal status of the leprosy patients in Dindigul district. Materials and Methods: The study was conducted on 62 patients treated in a leprosy center at Dindigul district. Among these, 22 (35.5%) were female patients and 40 were male patients (64.5%). Age ranges between 40 and 70 with the mean age being 52. Facial changes, periodontal status, dental caries, attrition, tooth loss, plaque index (Silness and Loe), and calculus component of oral hygiene index-simplified were assessed. Results: Majority of the patients presented with loss of eyebrows and eyelashes, saddle nose, ocular involvement, and leonine facies. Gingival recession (54.8%) was a predominant finding followed by tooth loss (69.5%), mobility (60.86%), attrition (56%), chronic pulpitis (34.7%), and dental caries (26%). Most of the patients had severe periodontitis. Conclusions: Compromised immunity and altered autonomy pave way for many dental complaints such as periodontitis and deposits in tooth with poor oral hygiene. Awareness about the oral health problems and reinforcement of oral hygiene should be insisted to the leprosy patients to prevent further morbidity.

Keywords: Dental caries, leprosy, multidrug therapy, periodontitis, plaque


How to cite this article:
Jacob Raja S A, Raja J J, Vijayashree R, Priya B M, Anusuya G S, Ravishankar P. Evaluation of oral and periodontal status of leprosy patients in Dindigul district. J Pharm Bioall Sci 2016;8, Suppl S1:119-21

How to cite this URL:
Jacob Raja S A, Raja J J, Vijayashree R, Priya B M, Anusuya G S, Ravishankar P. Evaluation of oral and periodontal status of leprosy patients in Dindigul district. J Pharm Bioall Sci [serial online] 2016 [cited 2022 Jul 6];8, Suppl S1:119-21. Available from: https://www.jpbsonline.org/text.asp?2016/8/5/119/191939

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae , which mainly affects the skin, peripheral nerves, upper respiratory tract, and the eyes. Left untreated, leprosy can be progressive, causing permanent damage to the skin, nerves, limbs, and eyes.[1],[2] Leprosy, which was supposed to be eradicated in India 8 years ago, still records the highest number of fresh cases globally. Leprosy was declared eliminated on January 1, 2006, with the prevalence of 0.98/10,000 populations in India.[2] Multidrug therapy being the main weapon against leprosy and has considerably reduced the incidence of leprosy in India significantly from 8.9/10,000 in 2000 to 1.1/10,000 in 2010. Yet, 1.34 lakh new leprosy cases were reported in India during the year 2009–2010. According to WHO, 65% of the fresh cases globally reported are from India. However, the prevalence of the disease has decreased considerably after the introduction of multidrug therapy.[3],[4] TThe efficacy of the therapy is largely dependent on the early diagnosis and the disease spreads by oronasal mucosa.[4],[5] The disease was first described clinically and microscopically by Armauer Hansen in 1874. Leprotic patients suffered from severe social stigma and were isolated from their families, communities, and even health professionals known since ancient times as “the death before death.”[6]

Periodontitis is a chronic inflammatory reaction produced by Gram-negative anaerobic bacteria predominantly resulting in the loss of alveolar bone and periodontal ligament. Periodontal disease, the lepromatous form of leprosy, is relatively common and is characterized by frequent gingival bleeding, papillary hypertrophy of the gums, tooth loss, and area of hypoesthesia at the border of alveolar mucosa. Leprosy patients are affected with deformities of hand such as claw hands, anesthesia, stiff joints, thumb paralysis, severe absorption, contractures, cracks, and wounds which further impair the maintenance of oral hygiene. There are only a very few studies to assess the oral and periodontal status of leprosy patients. The goal of this study was to evaluate the oral and periodontal findings in treated leprosy patients.


   Materials and Methods Top


The study was conducted on 26 patients treated in a leprosy center at Dindigul district. Of these, 8 (30%) were female patients and 18 were male patients (70%). Age ranges between 40 and 70 with the mean age being 52. Subjects diagnosed as leprotic (tuberculoid, borderline, and lepromatous) and under multidrug resistance therapy were included in the study. The study was done at various times in the subjects admitted to the leprosy center for the complaint of trophic ulcer. The purpose of the study was explained to the patients, and the informed consent was procured from them. Relative information collected includes patient's sex, age, familial history, type of disease, and facial complications of leprosy along with oral findings.

The patients were examined under natural light in the leprosy center. Periodontal complaints were examined with mouth mirror and periodontal probe. Albandar et al .'s criteria [7] were utilized to categorize the severity of periodontitis. According to his criteria, the periodontal probing depth was evaluated in millimeters, in all teeth in four dental areas (mesial, distal, buccal, and lingual) which considers periodontal disease extension and severity as follows: (1) Advanced periodontitis – two or more teeth (30% or more of the examined teeth) finding ≥5 mm probing depth; or four or more teeth (60% or more of examined teeth) finding ≥4 mm probing depth (2) moderate periodontitis – one or more teeth with ≥5 mm probing depth; or two or more teeth (30% or more of the teeth examined) finding ≥4 mm probing depth. (3) Mild periodontitis – one or more teeth with ≥3 mm probing depth. (4) Normal (no periodontitis) – six or more teeth which have not fulfilled any of the above criteria. Dental caries was diagnosed using mouth mirror and explorer. Other dental complaints such as attrition of teeth, tooth loss, and deposits on tooth also considered and taken into account. To assess the extent of plaque, Silness and Loe index [7],[8] was used and to categorize calculus deposits simplified oral hygiene index by Green and Vermillion were used.[9]


   Results Top


Results are calculated as counts and percentages. Among the 62 subjects examined in that center, 62.9% were of tuberculoid type and 37.1% were lepromatous type. [Table 1] shows the facial changes and the frequency distribution. The oral manifestations seen in those subjects were periodontal complaints (67.7%), attrition of teeth (54.8%), gingivitis (54.8%), and dental caries and chronic pulpitis (74.2%). Fissured tongue, oral macules, and angular cheilitis were seen in a few patients. Subjects were divided into two groups for tabulating the results [Table 2],[Table 3],[Table 4].
Table 1: Frequency distribution of facial changes

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Table 2: Comparison of oral manifestations between leprotic patients with and without systemic disease

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Table 3: Comparison of plaque and calculus between leprotic patients with and without systemic disease

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Table 4: Comparison of periodontitis between leprotic patients with and without systemic disease

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  • Leprotic patients with no systemic disease
  • Leprotic patients with systemic disease.



   Discussion Top


The surpassing oral complaint seen in these subjects was attrition and periodontitis. The affording factors to periodontitis are high plaque and calculus scores which can be attributed to their poor oral habits and affected autonomy. Leproti periodontitis was most commonly reported in leprotic patients, with more prevalence of periodontitis in lepromatous leprosy patients than tuberculoid type.[10]

Poor oral hygiene in this population was found to be attributed by the high-grade hand disorder. Moreover, there was a high degree of correlation between immune responses against periodontopathic bacteria in leprosy patients. Pocket depth and tooth loss were also observed more in patients with leprosy. Serum IgG against Porphyromonas gingivalis was found to be lesser in patients with leprosy.[10] The most common intraoral sites affected by leprosy include the hard and soft palate, in the uvula, on the underside of the tongue, and on the lips and gums.[11] Gingival recession was more pronounced in patients with leprosy followed by tooth loss, mobility, attrition, and chronic pulpitis.

Majority of the patients was found to have chronic periodontitis. Poor oral health and periodontal status were also reported in these patients in the study done by Núñez-Martí et al . in 2004. In the leprosy patients, a large proportion of maxillary incisors and canines were missing. The mean plaque index (Silness and Loe), probing depth, and attachment loss in leprosy patients were greater than in controls. The present study also validated Núñez-Martí's findings in the maxillary alveolar region. About 46.15% of the subjects presented with maxillary alveolar bone loss. According to the WHO, the most common oral pathologies are dental cavities and periodontal diseases. In the present study, the periodontal counterpart outweighed the caries counterpart. The most common reason reported for tooth loss in the edentulous persons was due to mobility. This can be due to poor oral habits and compromised immunity. Leprotic patients acquire the disease at a young age and after diagnosis of the disease they take a course of antibiotics as a part of multidrug therapy which are effective against Gram-positive bacteria which causes dental caries. However, further research needs to be carried to perceive this issue that if the huge load of antibiotic coverage prevents them from high caries count.[11],[12],[13],[14],[15]


   Conclusions Top


The conspicuous point of this study within its own limitations is that the compromised immunity and altered autonomy paves the way for many dental complaints such as periodontitis and deposits in tooth with poor oral hygiene due to ignorance contributing much to the trouble. Awareness about the oral health problems and reinforcement of oral hygiene should be insisted to the leprosy patients to prevent further morbidity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
McAdam AJ, Milner DA, Sharpe AH. Infectious diseases. In: Kumar V, Abbas AK, Aster JC, editors. Robbins and Cotran Pathologic Basis of Disease. 9th ed., Ch. 8. Philadelphia: Elsevier; 2010. p. 377.  Back to cited text no. 1
    
2.
Kumar A, Husain S. The burden of new leprosy cases in India: A population-based survey in two states. ISRN Trop Med 2013;2013: 1-8. (Article ID: 329283).  Back to cited text no. 2
    
3.
Kumar A, Girdhar A, Yadav VS, Girdhar BK. Some epidemiological observations on leprosy in India. Int J Lepr Other Mycobact Dis 2001;69:234-40.  Back to cited text no. 3
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4.
Rawlani SM, Rawlani S, Degwekar S, Bhowte RR, Motwani M. Oral health status and alveolar bone loss in treated leprosy patients of central India. Indian J Lepr 2011;83:215-24.  Back to cited text no. 4
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Thirugnanasambandan TS, Latha S, Kumar MS. Clinical and pathological evaluation of oral changes in leprosy. Indian J Multidiscip Dent 2011;1:105-9.  Back to cited text no. 5
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Dogra S, Narang T, Kumar B. Leprosy – Evolution of the path to eradication. Indian J Med Res 2013;137:15-35.  Back to cited text no. 6
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7.
Albandar JM, Brunelle JA, Kingman A. Destructive periodontal disease in adults 30 years of age and older in the United States, 1988-1994. J Periodontol 1999;70:13-29.  Back to cited text no. 7
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8.
Silness J, Loe H. Periodontal disease in pregnancy. II. Correlation between oral hygiene and periodontal condtion. Acta Odontol Scand 1964;22:121-35.  Back to cited text no. 8
    
9.
Greene JC, Vermillion JR. The simplified oral hygiene index. J Am Dent Assoc 1964;68:7-13.  Back to cited text no. 9
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Ohyama H, Hongyo H, Shimizu N, Shimizu Y, Nishimura F, Nakagawa M, et al. Clinical and immunological assessment of periodontal disease in Japanese leprosy patients. Jpn J Infect Dis 2010;63:427-32.  Back to cited text no. 10
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11.
Chimenos Küstner E, Pascual Cruz M, Pinol Dansis C, Vinals Iglesias H, Rodríguez de Rivera Campillo ME, López López J. Lepromatous leprosy: A review and case report. Med Oral Patol Oral Cir Bucal 2006;11:E474-9.  Back to cited text no. 11
    
12.
Núñez-Martí JM, Bagán JV, Scully C, Peñarrocha M. Leprosy: Dental and periodontal status of the anterior maxilla in 76 patients. Oral Dis 2004;10:19-21.  Back to cited text no. 12
    
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Souza VA, Emmerich A, Coutinho EM, Freitas MG, Silva EH, Merçon FG, et al. Dental and oral condition in leprosy patients from Serra, Brazil. Lepr Rev 2009;80:156-63.  Back to cited text no. 13
    
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Costa A, Nery J, Oliveira M, Cuzzi T, Silva M. Oral lesions in leprosy. Indian J Dermatol Venereol Leprol 2003;69:381-5.  Back to cited text no. 14
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Abdalla LF, Santos JH, Collado CS, Souza Cunha Mda G, Naveca FG. Mycobacterium leprae in the periodontium, saliva and skin smears of leprosy patients. Rev Odontol Ciênc 2010;25:148-53.  Back to cited text no. 15
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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