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Periodontal diseases in Asians.

Asia encompasses three of the four most populous nations in the world (China, India and Indonesia), accounting for nearly two-fifths of the worlds' total population. Over half of the world's population now inhabits Asia, which by definition includes countries of the Middle East and some former Socialist Soviet Republics. There has been a generally held view that Asians are particularly susceptible to periodontitis. The aim of this review is to consider the reasons for this view having become entrenched and to examine the evidence on which it could have been established and sustained. This view of a particularly high prevalence of periodontal diseases in Asians appears in retrospect to have originated from early epidemiological studies using an index system which gives weight to gingivitis and moderate periodontitis resulting from poor oral hygiene and calculus deposition, very commonly encountered in Asian populations. Studies that have been conducted comparing Asians immigrants with native Caucasians in industrialized northern hemisphere nations broadly concluded that Asians displayed worse periodontal conditions than Caucasians. Similarly, a classic study comparing Norwegian males with Sri Lankan Tamil males demonstrated worse periodontal conditions in the Asian males. A recent review (Albander and Rams, 2002) has stated that those of African origin display the highest prevalence of periodontitis followed by Hispanics and Asians. Studies of the natural history of periodontal disease in Asians, of perio-dontopathogens in Asians, of risk for periodontal destruction, and of reasons for extraction do not appear to explain increased susceptibility of Asians to periodontal destruction. Poor oral hygiene and calculus deposits are widespread, however. Traditional assessments of periodontitis focus on destruction of the periodontal attachment in terms of attachment loss and probing pocket depths, with no consideration being given to the morphological features of the dentition from which the periodontal attachment is being lost, features that may predispose to or complicate the management of periodontal destruction. The Mongoloid dentition shows a high prevalence of such features, which adds a further dimension to the consideration of periodontal diseases among many Asian peoples. Appropriate strategies for the prevention and management of periodontal disease should focus upon improvements in the oral hygiene situation in the diverse continent of Asia.