Original Research
Oral Health / Epidemiology

Proportion and Factors Related to Periodontal Disease

Last reviewed: March 2026

Introduction

Periodontal disease encompasses a group of inflammatory conditions affecting the supporting structures of the teeth, ranging from mild gingivitis (inflammation of the gingiva) to severe periodontitis (destruction of the alveolar bone and periodontal ligament). Globally, periodontal diseases are among the most prevalent chronic conditions, affecting billions of people worldwide. Severe periodontitis has been identified as the eleventh most prevalent disease globally according to Global Burden of Disease analyses.

In Malaysia, the burden of periodontal disease is particularly high. National oral health surveys have consistently documented that the vast majority of Malaysian adults with natural teeth exhibit some form of periodontal condition. Data from the National Oral Health Survey of Adults revealed that approximately 94% of dentate Malaysian adults had some form of periodontal disease, making it one of the most common health conditions in the population. The prevalence showed a slight decline between 1990 and 2000 but increased again by 2010, suggesting that prevention efforts have not yet reversed the trend.

This study investigated the proportion of individuals affected by periodontal disease in a defined Malaysian population and examined the factors associated with the condition. Understanding the distribution and determinants of periodontal disease is essential for planning effective preventive strategies and allocating healthcare resources appropriately.

Methodology

The study employed a cross-sectional design to assess periodontal status and associated factors among adults attending healthcare facilities. Periodontal assessment was conducted using established clinical indices that evaluate key indicators of periodontal health, including gingival bleeding on probing, pocket depth measurement, and clinical attachment loss. These measurements provide a comprehensive picture of both current inflammation and cumulative tissue destruction.

Participants completed structured questionnaires capturing sociodemographic information (age, sex, ethnicity, education, income, occupation), behavioural factors (smoking status, oral hygiene practices including brushing frequency and interdental cleaning), medical history (particularly diabetes mellitus, cardiovascular disease, and other systemic conditions), and dental service utilisation patterns.

Statistical analysis included descriptive characterisation of periodontal disease prevalence across demographic subgroups, followed by bivariate and multivariable analyses to identify factors independently associated with periodontal disease. Logistic regression models were used to estimate odds ratios with 95% confidence intervals, adjusting for potential confounders.

Findings

The study confirmed a high proportion of participants with clinical evidence of periodontal disease, consistent with the broader epidemiological picture in Malaysia. The distribution of disease severity varied across the study population, with a notable proportion showing evidence of advanced periodontal destruction in addition to the more commonly observed mild to moderate disease.

Age emerged as a significant factor, with the prevalence and severity of periodontal disease increasing progressively with advancing age. This age-related pattern reflects the cumulative nature of periodontal tissue destruction and the increasing duration of exposure to risk factors over the lifespan. Among the behavioural factors examined, tobacco smoking showed one of the strongest associations with periodontal disease, consistent with the extensive international evidence base implicating smoking as a major modifiable risk factor for periodontitis.

Oral hygiene practices were significantly associated with periodontal status. Individuals who reported regular brushing twice daily and use of additional interdental cleaning aids had lower prevalence of periodontal disease compared to those with less frequent or less thorough oral hygiene routines. Access to and utilisation of professional dental services also showed an association, with regular dental attendees generally having better periodontal outcomes.

Among systemic health factors, diabetes mellitus demonstrated a particularly strong association with periodontal disease, reflecting the well-established bidirectional relationship between these two conditions. Diabetes impairs immune function and wound healing, predisposing individuals to more severe periodontal destruction, while severe periodontitis may adversely affect glycaemic control through systemic inflammatory mediators.

Periodontal Disease in the Malaysian Population Context

Malaysia’s multiethnic population presents unique considerations for understanding periodontal disease epidemiology. Differences in dietary habits, cultural practices related to oral hygiene (including the use of traditional tooth-cleaning materials among some communities), tobacco and betel quid use patterns, and access to dental services across ethnic groups may contribute to observed variations in periodontal disease prevalence.

The Malaysian healthcare system provides dental services through both public sector facilities (including dental clinics within government health centres and hospitals) and a growing private dental sector. However, analysis of service delivery patterns has revealed that the mix and distribution of periodontal treatment provided in public dental clinics may not fully match the population’s increasing needs for complex periodontal care. While routine scaling and polishing are widely provided, more advanced periodontal procedures represent a small fraction of services delivered.

Public Health Implications and Significance

The high proportion of periodontal disease documented in this study has significant implications for Malaysian public health policy and practice. Given the established links between periodontal disease and systemic conditions including diabetes, cardiovascular disease, and adverse pregnancy outcomes, addressing periodontal health is relevant not only to oral health specifically but to chronic disease prevention more broadly.

The identification of modifiable risk factors—particularly smoking and inadequate oral hygiene—suggests that health promotion interventions targeting these behaviours could yield substantial benefits for periodontal health at the population level. Integration of oral health education into existing chronic disease management programmes, particularly diabetes care, represents an evidence-based approach that aligns with the common risk factor paradigm increasingly advocated in public health.

The findings also support the case for expanding access to preventive dental services, particularly among underserved populations, and for strengthening the capacity of Malaysia’s primary healthcare system to deliver periodontal screening and early intervention as part of routine health assessments.

Limitations

As a facility-based cross-sectional study, the findings may not be fully generalisable to the broader Malaysian population, as individuals attending healthcare facilities may differ systematically from non-attendees in terms of health status and health-seeking behaviour. The cross-sectional design precludes causal inference regarding the identified associations. Self-reported data on behavioural factors such as smoking and oral hygiene practices may be subject to social desirability bias. The study’s scope did not include microbiological assessment of periodontal pathogens, which would have provided additional insight into disease aetiology.

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