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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 5  |  Page : 436-439  

Analysis of age and gender-related changes in gingival width in patients of known population: A scross-sectional study


1 Department of Human Anatomy, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
2 Department of Periodontics, Patna Dental College and Hospital, Patna, Bihar, India
3 Consultant Orthodontist, Udaipur, India
4 Department of Prosthodontics, Baba Jaswant Singh Dental College and Hospital, Ludhiana, Punjab, India
5 Department of conservative Dentistry, Baba Jaswant Singh Dental College, Ludhiana, Punjab, India
6 Department of Periodontics, Desh Bhagat Dental College and Hospital, Mandi Gobindgarh, Punjab, India

Date of Submission25-Sep-2020
Date of Decision25-Sep-2020
Date of Acceptance26-Sep-2020
Date of Web Publication05-Jun-2021

Correspondence Address:
Purushottam Singh
Department of Periodontics, Patna Dental College and Hospital, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.JPBS_584_20

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   Abstract 


Aims: The present study was conducted for analyzing age and gender-related alterations in gingival width (GW) in patients of known population. Materials and Methods: Two hundred and ten healthy participants were enrolled in the present research. All the participants were divided into the following study groups with seventy participants in each group based on their age: adolescents, young adults, and older adults. All the participants were recalled and oral and periodontal examination was carried out using mouth mirror, probe, and explorer. Lidocaine spray was used for anesthetizing the anterior gingival region. A probe was used for assessing the width of the gingiva, in which and rubber stopper was fitted. In all the six maxillary anterior and mandibular anterior teeth, the width and thickness of the attached gingivae were assessed. All the measurements were recorded and analyzed. Results: Mean width of the attached gingiva in the maxillary arch in adolescents, young adults, and older adults were found to be 2.51 mm, 2.93 mm, and 3.92 mm, respectively. Mean width of the attached gingiva in the mandibular arch in adolescents, young adults, and older adults were found to be 1.76 mm, 2.39 mm, and 3.19 mm, respectively. Significant results were observed while comparing the GW among participants divided on the basis of age group. Nonsignificant results were observed while comparing the GW among participants divided on the basis of gender. Conclusion: There is a significant enhancement of GW with the advancement of age in both the maxillary arch and mandibular arch.

Keywords: Gingiva, periodontal, width


How to cite this article:
Gandhi V, Singh P, Bakshi R, Singh R, Sood R, Brar AS. Analysis of age and gender-related changes in gingival width in patients of known population: A scross-sectional study. J Pharm Bioall Sci 2021;13, Suppl S1:436-9

How to cite this URL:
Gandhi V, Singh P, Bakshi R, Singh R, Sood R, Brar AS. Analysis of age and gender-related changes in gingival width in patients of known population: A scross-sectional study. J Pharm Bioall Sci [serial online] 2021 [cited 2021 Jun 23];13, Suppl S1:436-9. Available from: https://www.jpbsonline.org/text.asp?2021/13/5/436/317560




   Introduction Top


A key part in sustaining the periodontal well-being is played by the biotype of the gingiva. This is because the structure of the periodontium dictates its reaction toward different physical and microbial challenges. Not only this but also even various treatment protocols including the surgical and orthodontic strategies require proper evaluation of gingival biotype.[1],[2] It is rare to observe any pathological development when optimum orthodontic pressure is applied within the structural limits of alveolar bone to bring about movement of the maxillary anterior teeth in the anteroposterior direction. On the other hand, if forces exceeding the sustainable capacity of the osseous components are applied, fenestrations, and dehiscence may occur. In these cases, there are greater chances of the recession of gingiva owing to loss of alveolar bone, and this condition may further be aggravated if the patient presents with a thin gingival biotype.[3],[4]

The process of getting old is biologically and physiologically a natural one. Intraoral and extraoral structures just like the other body tissues undergo a plethora of changes as they get old. With age even the smile of an individual changes owing to the changes in the musculature which regulates the smiling process.[5],[6] Hence, the present study was conducted for analyzing age and gender-related alterations in gingival width (GW) in patients of known population.


   Materials and Methods Top


Two hundred and ten healthy participants were enrolled in the present research. Random selection of the participants was done from the general population and who gave consent for participation in the study.

Inclusion criteria

  • Participantswith healthy periodontal status
  • Participantswith the absence of any attachment loss
  • Participantshave complete dentition (excluding third molars).


Exclusion criteria

  • Diabetic and hypertensive subjects
  • Participantswith the presence of gingival recession
  • Pregnant participants
  • Participantson any form of long-term medications.


All the participantswere divided into the following study groups with seventy participantsin each group based on their age:

  • Adolescents: Age range between 15 and 20 years
  • Young adults: Age range between 21 and 40 years
  • Older adults: Age range of >40 years.


It was ensured that all three study groups consisted of equal proportion of male and female populations. All the participantswere recalled and oral and periodontal examination was carried out using a mouth mirror, probe, and explorer. Lidocaine spray was used for anesthetizing the anterior gingival region. This was done for assessing the width of the attached gingiva by stretching the lips. From the total attached GW, sulcus depth was subtracted, and hence the width of the attached gingivae was obtained. For performing this function, a probe was used in which and rubber stopper was fitted. A ruler was used for making the final measurements. The thickness of the gingiva was assessed by measuring the halfway distance midbuccally between the mucogingival junction and the free gingival groove in the attached gingiva. In all the six maxillary anterior and mandibular anterior teeth, the width and thickness of the attached gingivae were assessed. All the measurements were recorded and analyzed. For statistical analysis, Student's t-test was used.


   Results Top


Two hundred and ten healthy participants were enrolled in the present research. All the participants were divided into the following study groups with seventy participants in each group based on their age: adolescents, young adults, and older adults. Mean width of the attached gingiva in the maxillary arch in adolescents, young adults, and older adults were found to be 2.51 mm, 2.93 mm, and 3.92 mm, respectively as shown in [Table 1] ad [Graph 1]. Mean width of the attached gingiva in the mandibular arch in adolescents, young adults, and older adults were found to be 1.76 mm, 2.39 mm, and 3.19 mm, respectively. Significant results were observed while comparing the GW among participants divided on the basis of age group. Mean width of the attached gingiva in the maxillary arch in males and females was found to be 3.18 mm, and 2.87 mm, respectively as shown in [Table 2]. The mean width of the attached gingiva in the mandibular arch in male's and females was found to be 3.26 mm, and 2.92 mm, respectively. Nonsignificant results were observed while comparing the GW among participants divided on the basis of gender.
Table 1: Comparison of width of attached gingiva among subjects divided on the basis of age group

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Table 2: Comparison of width of attached gingiva among subjects divided on the basis of gender

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   Discussion Top


Oral hard and soft tissues develop clinical variations and histological modifications with advancing age. Not only are the functional variations observed with age but also morphological modifications of the environment inside the mouth are experienced. The morphology of the periodontal tissues among the aged population represents features such as atrophic changes in the mucous membrane, which becomes very delicate and shows loss of stippling pattern. Thinning of the epithelium and decreased elasticity of the connective tissues are other presentations. There is also a reduction in the number of blood capillaries leading to decreased supply of blood.[5],[6],[7]

There are various ways to determine the gingival biotype of an individual. Some of them include direct inspection under vision, with the aid of a periodontal probe or with the help of certain instruments such as the spreaders and files used in root canal treatment and different types of calipers. It should be emphasized that only the thickness from the buccal to the palatal aspect is of prime scientific importance to determine the thickness and thinness of the biotype. Plenty of invasive as well as noninvasive means is advocated to ascertain the gingival tissue thickness.[8] Hence, the present study was conducted for analyzing age and gender-related alterations in gingival thickness in patients of known population.

In the present study, two hundred ten healthy participants were enrolled. Mean width of the attached gingiva in the maxillary arch in adolescents, young adults, and older adults were found to be 2.51 mm, 2.93 mm, and 3.92 mm, respectively as shown in [Table 1] ad [Graph 1]. Mean width of the attached gingiva in the mandibular arch in adolescents, young adults, and older adults were found to be 1.76 mm, 2.39 mm, and 3.19 mm, respectively. Significant results were observed while comparing the GW among participants divided on the basis of age group. In a previous study conducted by Joshi et al., authors carried out a comparison of the gingival biotype among male and female patients. They included 800 patients in their study with equal contribution from each gender. Photographs were used to evaluate the height of the papilla and the ratio between the width of the crown and its height. Clinical evaluation was carried out to ascertain the width and thickness of keratinized gingiva (GW). Radiographs aided in gingival and alveolar bone thickness calculations. Variations in the male and female data were evaluated. They found thin gingiva in females in comparison to males. Even the thickness of the alveolar bone was lesser in females.[9]

In the present study, nonsignificant results were observed while comparing the GW among partcipants divided on the basis of gender. Plenty of methods have been advocated to calculate the thickness of the tissues. Measurements can be made directly. Ultrasonic devices can also be used. Of late even cone-beam computed tomography has been used. Kydd et al. used ultrasonic apparatus with echo-ranging to assess masticatory mucous membrane thickness at certain specified locations when at a resting state. They then studied the variations in its thickness under compressive forces.[10],[11],[12] Manjunath et al. evaluated the biotype of gingiva between opposite gender patients with the help of transgingival probing. Three hundred and thirty-six participants with representation from both the genders were involved in this study and the thickness of their gingiva was assessed. The study observed a significant difference between the data assessed from both genders. Males were found to have a greater thickness of the gingiva. Only 13.3% of females had a thick biotype in contrast with 76.9% males. Very few studies have tried to compare the biotype of gingiva among the opposite gender with different ages.[13] Singh et al. carried out a study to compare the thickness and width of the gingiva, the depth of probing, and the fill of papilla in the front region of the maxilla. The undergraduate pupils and interns of the dental institute were included in this study. In every patient, six teeth were evaluated. Two thousand and one hundred and seventy-eight upper front teeth were assessed. GT and GW showed a positive correlation between them. The corelation between GT and PD was not significant; it was same with GT and PF. They concluded that a positive correlation exists between GT and GW, whereas the corelation between GT and PD was weakly negative.[14] Agarwal et al. evaluated the differences in the gingival thickness based on demography and location within the arch. A total of ninty partcipants were involved in the study. They were segregated into three separate age groups. Irrespective of the arch a significant decrease in the gingival thickness was observed with advancing age. The gingival thickness was more in females. The upper arch showed greater thickness of gingiva in comparison to the lower arch.[15]


   Conclusion Top


There is a significant enhancement of GW with the advancement of age in both the maxillary arch and mandibular arch. Although nonsignificant, males had higher slightly more GW in comparison to females. However; further studies are recommended for the better elucidation of results.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Olsson M, Lindhe J. Periodontal characteristics in individuals with varying form of the upper central incisors. J Clin Periodontol 1991;18:78-82.  Back to cited text no. 1
    
2.
Kao RT, Fagan MC, Conte GJ. Thick vs. thin gingival biotypes: A key determinant in treatment planning for dental implants. J Calif Dent Assoc 2008;36:193-8.  Back to cited text no. 2
    
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Renkema AM, Fudalej PS, Renkema A, Kiekens R, Katsaros C. Development of labial gingival recessions in orthodontically treated patients. Am J Orthod Dentofacial Orthop 2013;143:206-12.  Back to cited text no. 3
    
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Yared KF, Zenobio EG, Pacheco W. Periodontal status of mandibular central incisors after orthodontic proclination in adults. Am J Orthod Dentofacial Orthop 2006;130:6.e1-8.  Back to cited text no. 4
    
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Desai S, Upadhyay M, Nanda R. Dynamic smile analysis: Changes with age. Am J Orthod Dentofacial Orthop 2009;136:310.e1-10.  Back to cited text no. 5
    
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Singh B, Ahluwalia R, Verma D, Grewal SB, Goel R, Kumar PS. Perioral age-related changes in smile dynamics along the vertical plane: A videographic cross-sectional study. Angle Orthod 2013;83:468-75.  Back to cited text no. 6
    
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Andreescu CF, Mihai LL, Răescu M, Ţuculină MJ, Cumpătă CN, Ghergic DC. Age influence on periodontal tissues: A histological study. Rom J Morphol Embryol 2013;54:811-5.  Back to cited text no. 7
    
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De Rouck T, Eghbali R, Collys K, De Bruyn H, Cosyn J. The gingival biotype revisited: transparency of the periodontal probe through the gingival margin as a method to discriminate thin from thick gingiva. J Clin Periodontol 2009;36:428-33.  Back to cited text no. 8
    
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Joshi A, Suragimath G, Zope SA, Ashwinirani SR, Varma SA. Comparison of gingival biotype between different genders based on measurement of dentopapillary complex. J Clin Diagn Res 2017;11:ZC40-5.  Back to cited text no. 9
    
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Kan JY, Rungcharassaeng K, Umezu K, Kois JC. Dimensions of peri-implant mucosa: An evaluation of maxillary anterior single implants in humans. J Periodontol 2003;74:557-62.  Back to cited text no. 10
    
11.
Müller HP, Heinecke A, Schaller N, Eger T. Masticatory mucosa in subjects with different periodontal phenotypes. J Clin Periodontol 2000;27:621-6.  Back to cited text no. 11
    
12.
Kydd WL, Daly CH, Wheeler JB 3rd. The thickness measurement of masticatory mucosa in vivo. Int Dent J 1971;21:430-41.  Back to cited text no. 12
    
13.
Manjunath RG, Rana A, Sarkar A. Gingival Biotype Assessment in a Healthy Periodontium: Transgingival Probing Method. J Clin Diagn Res 2015;9:ZC66-9.  Back to cited text no. 13
    
14.
Singh J, Rathod VJ, Rao PR, Patil AA, Langade DG, Singh RK. Correlation of gingival thickness with gingival width, probing depth, and papillary fill in maxillary anterior teeth in students of a dental college in Navi Mumbai. Contemp Clin Dent 2016;7:535-8.  Back to cited text no. 14
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Agarwal V, Sunny, Mehrotra N, Vijay V. Gingival biotype assessment: Variations in gingival thickness with regard to age, gender, and arch location. Indian J Dent Sci 2017;9:12-5.  Back to cited text no. 15
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