A Study of Risk Factors Concerned the Onset of Periodontal Infection in the Least Developed Countries: The First Report-The Influences of the Living Environments Risk Factors at Rural Area in Kingdom of Cambodia-

Abstract

General Principles and Objects : According to the background of the crisis in periodontal infection, it is necessary to conceptualize the risk management concerning relationship between various risk factors and systemic damages in rural areas of the least developed countries. The Organization of International Support for Dental Education (OISDE), in cooperation with Japan International Cooperation Agency (JICA), has started to implement a primary health care program focused in the prevention of systemic damages caused by periodontal infection since 2003 to stretch over one year and six months. The program has been applied to 7 provinces and 25 districts with beneficiary residents of over 1,300 according to the methodology. In this study, the targeted area was focused two typical rural health centers in Stung Treng province. The project had been implemented three times in these health centers since January 2004 to March 2005 and the number of residents who checked our examination and primary health care were 194. Sixty residents who live in the downtown of Phnom Penh city were served as control group in quite advanced living environment conditions.The purpose of this study is to investigate the influence of risk factors associated with poor living environment to the crisis in periodontal infection in rural area in the Kingdom of Cambodia as a field study.Methods : Basic information of all visiting residents was charted according to our original concept. Living environment (LE) risk factors were charted based on a five-grade method. The contents of LE were as follows : 1) medical supply condition which means the distance from the referred hospital including private medical clinic, health center and health post, 2) sanitary (toilet) facility, 3) provision of safe water supply, and 4) situation of living in close proximity with the livestock. Medical systemic conditions of the residents were charted by interview method into history of systemic diseases and history of tropical infections. Also, general health conditions including physical examination of the heart and lungs sound, measurement of blood pressure, urine test and simply ECG (electrocardiogram) were assessed by the physician. The dental intelligence quotient (dental IQ) concerning periodontal infection was charted by question and answer method according to a five-grade classification. The periodontal infection was evaluated by dentists using a four-point method measurement of periodontal pocket depth, bleeding on probing (BOP), and mobility of each tooth. Plaque-induced gingival inflammation was examined by plaque control record (PCR method by O'Leary), which used a staining solution. At the same time, occlusal problems caused by missing tooth/teeth, decay, and orthodontic problem were confirmed.Results : Statistical analysis by multiple regression analysis reveals that age ; plaque accumulation status, and living environment have very significant influences to the periodontal inflammatory status. The result demonstrates the situation of the living environment as a significant influence to the cause of periodontal inflammation.Conclusion : The poor living and unsanitary environment may provide the vicious cycle of recurrent or prolonged infections leading to severe oxidative changes caused by the hyper functioning immune system. The end result of which is a hastened aging process. Therefore, a better living environment for the rural area residents is a must in order to prevent periodontal infections, as well as infectious tropical diseases.