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Volume 77 • Number 6

Relationship Among Gender, Race, Age,


Gingival Width, and Probing Depth in
Primary Teeth
Isaac Suzart Gomes-Filho,* Dario Augusto Oliveira Miranda,* Soraya Castro Trindade,* Carlos
Antônio de Souza Teles Santos,* Camila Oliveira Teixeira de Freitas,* Simone Seixas da Cruz,*
Taı́ze Cássia Nascimento de Macêdo,* and Johelle de Santana Passos*

Background: Limited information is available regarding


the attached keratinized tissue, probing depth, and sociode-
mographic characteristics of primary teeth. This study was
carried out to evaluate the relationship among age, gender,
race, gingival width, and probing depth in each primary tooth
type.

D
ifferent forms of periodontal dis-
Methods: The study population consisted of 300 children, ease can present in children,
aged 4 to 6 years, with clinically healthy gingiva, who were en- ranging from reversible condi-
rolled in an oral health program. Gingival width and probing tions limited to the gingival tissue to
depth were measured with a standard Williams periodontal those that destroy the connective tissue
probe in the middle of the keratinized gingiva and at six gin- attachment and alveolar bone, which
gival sites (mesio-buccal, mid-buccal, disto-buccal, mesio- may jeopardize the longevity of the pri-
lingual, mid-lingual, and disto-lingual), respectively. Schiller’s mary or permanent dentition. Because
solution was used to establish the limits of keratinized gingiva. there is a much lower prevalence of de-
Results: The gingival width (mean – SD) on the buccal sur- structive periodontal disease in children
faces decreased from anterior to posterior positions in both than in adults, diagnosis in children is
arches; in the lower lingual surfaces, the inverse was observed. more difficult. However, because early
The gingival width (mean – SD) ranged from 2.95 – 0.15 mm diagnosis is important for successful
to 6.16 – 0.20 mm and the probing depth from 1.03 – 0.91 mm treatment, it is imperative that children
to 2.08 – 0.07 mm. There was a tendency toward increased receive a periodontal examination as
probing depth as age increased from 4 to 6 years. There was part of their routine dental visits.
also an increase in the probing depth from anterior to posterior Periodontal probing depth (PD) is an
teeth. important diagnostic method to evaluate
Conclusions: In the majority of observations, it was con- the presence and severity of periodontal
cluded that there was a relationship among age, gingival disease and to monitor the effectiveness
width, and probing depth, but generally not among race and of treatment. In permanent teeth, a PD
gender and these measurements, respectively. Furthermore, between 0 and 3 mm is considered nor-
there is no relation between gender and gingival width and mal. In histologic terms, this measure-
race and probing depth. J Periodontol 2006;77:1032-1042. ment frequently represents penetration
KEY WORDS of the probe through the base of the sul-
Anatomy; gingiva; primary teeth. cus into the junctional epithelial cells (1 to
1.5 mm apical from the bottom of the his-
tologic sulcus).1 An increase in PD is often
* Department of Periodontics, Feira de Santana State University, Bahia, Brazil. related to the progression or recurrence
of periodontitis. There are several vari-
ables to be considered when measuring
PD: the force applied during probing,
the probe diameter, the probe insertion
angle, anatomical and pathologic fac-
tors, and inflammation of the periodontal
tissues.2-6

doi: 10.1902/jop.2006.050198

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J Periodontol • June 2006 Gomes-Filho, Miranda, Trindade, et al.

Table 1.
Gingival Width on Buccal Surfaces of Maxillary Teeth Using Random Coefficient
Analysis for Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD (mm) Age Gender Race

4 121 4.72 – 0.185


5 189 4.98 – 0.162
Central incisor 6 72 5.38 – 0.192
P = 0.18 0.009 NS NS
Random effect
var(Uoi ) 1.14, var(R ti) 0.59
4 124 4.53 – 0.156
5 223 4.89 – 0.136
Lateral incisor 6 148 5.26 – 0.156
P = 0.0071 0.0002 NS NS
Random effect
var(Uoi) 0.96, var(R ti) 0.53
4 123 3.59 – 0.141
5 235 4.06 – 0.122
Canine 6 191 4.27 – 0.140
P = 0.0036 0.0001 NS NS
Random effect
var(Uoi) 0.87, var(R ti) 0.55

4 122 3.18 – 0.120


5 229 3.49 – 0.104
First molar 6 171 3.89 – 0.120
P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.7, var(R ti) 0.57

4 121 3.74 – 0.140


5 229 4.09 – 0.121
Second molar 6 178 4.43 – 0.137
P = 0.0012 0.0001 NS NS
Random effect
var(Uoi) 0.86, var(R ti) 0.48
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.

Although periodontal PD is an important clinical to the 1996 Consensus Report on Mucogingival Ther-
tool for diagnosing periodontal disease and evaluating apy,21 indications still exist for increasing the width of
therapy, this procedure has limitations because it keratinized tissue because of its importance in main-
does not detect current disease activity but merely taining periodontal health. However, it has been sug-
demonstrates the past destruction pattern. The nor- gested that keratinized tissue may not be needed in
mal PDs in primary teeth have not been clearly many situations.22
defined, and there are only a few studies in this Most of the research addressing gingival width in
area.7-17 primary teeth was done in children in their own coun-
The evaluation of gingival width in primary teeth tries of residence.7-9,14,17,23-25 Research involving
has not been thoroughly investigated. The impor- different nationalities may identify ethnic differences
tance of attached keratinized tissue around natural not found in previous studies. It should also be noted
teeth is a controversial topic18-20 since, historically, that a country’s population can include a number of
an adequate band of keratinized tissue was viewed ethnic groups, each of which may possess unique
as important to prevent future recession.20 According genetic characteristics.

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Gingival Width and Probing Depth in Primary Teeth Volume 77 • Number 6

Table 2.
Gingival Width on Buccal Surfaces of Mandibular Teeth Using Random Coefficient
Analysis for Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD (mm) Age Gender Race

4 117 5.07 – 0.129


5 219 5.11 – 0.104
Central incisor 6 140 5.43 – 0.119
P = 0.0115 0.011 NS NS
Random effect
var(Uoi) 0.72, var(R ti) 0.37
4 119 4.78 – 0.109
5 230 4.85 – 0.929
Lateral incisor 6 176 5.17 – 0.104
P = 0.037 0.001 NS NS
Random effect
var(Uoi) 0.59, var(R ti) 0.54
4 123 3.38 – 0.109
5 237 4.04 – 0.090
Canine 6 191 4.18 – 0.092
P = 0.053 0.016 NS NS
Random effect
var(Uoi) 0.58, var(R ti) 0.53

4 125 3.35 – 0.086


5 233 3.49 – 0.075
First molar 6 184 3.81 – 0.086
P = 0.000 0.000 NS 0.04
Random effect
var(Uoi) 0.42, var(R ti) 0.53

4 122 3.94 – 0.103


5 232 4.08 – 0.088
Second molar 6 187 4.35 – 0.101
P = 0.0009 0.001 NS NS
Random effect
var(Uoi) 0.60, var(R ti) 0.44
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.

In the 1980s, it was believed that the integrity of pri- (white, clear mulatto, medium mulatto, dark mulatto,
mary teeth and their structures could influence the and black26,27), and mean (– SD) values of gingival
stability of occlusion and the health of the permanent width and PD in each primary tooth type.
dentition.6 Among the many aspects evaluated, the
gingival width may play an important role in the ho-
meostasis of the periodontium by resisting traumatic MATERIALS AND METHODS
damage to the gingiva. The rationale for evaluating A total of 300 children (153 boys and 147 girls), rang-
adequate gingival width included facilitating plaque ing in age from 4 to 6 years, from Dagmar Silva
control and improving patient comfort in conjunction School, Feira de Santana, Bahia, Brazil, participated
with restorative or prosthetic dentistry. There are a num- in this cross-sectional study. All of the children were
ber of factors that influence gingival width, including in an oral health program that included weekly oral
tooth location, age, and genetics. The objective of this hygiene motivation and application of 1.23% fluoride
research was to evaluate the relationship among age using a toothbrush. Clinical visits included scaling,
(4, 5, and 6 years), gender (boys and girls), race restorations, and extractions as needed.

1034
J Periodontol • June 2006 Gomes-Filho, Miranda, Trindade, et al.

Table 3.
Gingival Width on Lingual Surfaces of Mandibular Teeth Using Random Coefficient
Analysis for Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD (mm) Age Gender Race

4 121 2.95 – 0.154


5 189 3.38 – 0.142
Central incisor 6 72 3.74 – 0.190
P = 0.0055 0.0004 NS NS
Random effect
var(Uoi) 0.96, var(R ti) 0.26
4 124 3.13 – 0.147
5 223 3.76 – 0.131
Lateral incisor 6 148 4.20 – 0.151
P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.89, var(R ti) 0.52
4 123 4.05 – 0.152
5 235 4.56 – 0.132
Canine 6 191 4.87 – 0.149
P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.93, var(R ti) 0.56

4 122 4.85 – 0.175


5 229 5.26 – 0.155
First molar 6 171 5.49 – 0.177
P = 0.0226 0.007 NS NS
Random effect
var(Uoi) 1.07, var(R ti) 0.67

4 121 5.66 – 0.199


5 229 6.02 – 0.177
Second molar 6 178 6.16 – 0.199
P = 0.1999 NS NS NS
Random effect
var(Uoi) 1.26, var(R ti) 0.63
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.

The research project was approved by the Ethics PD Measurements


Research Committee of São Rafael Hospital, in PD was measured by a single calibrated examiner
Salvador, Bahia, Brazil. Informed consent forms were using a standardized Williams periodontal probe at
signed by parents or adults who were responsible for six sites: mesio-buccal, mid-buccal, disto-buccal,
the children. mesio-lingual, mid-lingual, and disto-lingual. All mea-
surements were rounded to the nearest millimeter.
Gingival Width Measurements
The mucogingival junction was identified by stain- Intraexaminer Reliability
ing with Schiller’s solution (an iodine-based sub- The examiner in the study was selected because of
stance) to establish the limits of keratinized gingiva. significant previous experience. The intraexaminer cal-
Gingival width was measured in the middle area on ibration was performed before the study began. Reli-
each tooth from the gingival margin to the mucogin- ability was determined by having the examiner make
gival junction using a standardized periodontal probe. dual measurements, along with those of the project
All measurements were rounded to the nearest milli- director (ISGF), in at least two patients and to indicate
meter. any measurement differences >1 mm. Reliability was

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Gingival Width and Probing Depth in Primary Teeth Volume 77 • Number 6

Table 4.
Probing Depth on Buccal Sites of Primary Teeth Using Random Coefficient Analysis for
Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD Age Gender Race

4 112 1.26 – 0.098


5 221 1.44 – 0.087
Central incisor 6 140 1.55 – 0.089
(maxilla) P = 0.018 0.039 NS NS
Random effect
var(Uoi) 0.50, var(R ti) 0.29
4 115 1.09 – 0.072
5 232 1.18 – 0.063
Lateral incisor 6 177 1.27 – 0.064
(maxilla) P = 0.0021 0.034 0.030 NS
Random effect
var(Uoi) 0.31, var(R ti) 0.36
4 120 1.27 – 0.075
5 238 1.28 – 0.066
Canine 6 193 1.37 – 0.065
(maxilla) P = 0.0021 NS NS NS
Random effect
var(Uoi) 0.31, var(R ti) 0.36
4 122 1.17 – 0.072
5 235 1.22 – 0.063
First molar 6 186 1.29 – 0.064
(maxilla) P = 0.07 NS NS NS
Random effect
var(Uoi) 0.31, var(R ti) 0.39
4 119 1.80 – 0.071
5 234 1.85 – 0.062
Second molar 6 189 1.76 – 0.061
(maxilla) P = 0.06 NS NS NS
Random effect
var(Uoi) 0.32, var(R ti) 0.36
4 115 1.04 – 0.087
5 188 1.14 – 0.082
Central incisor 6 72 1.54 – 0.097
(mandible) P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.42, var(R ti) 0.26

4 119 1.11 – 0.710


5 224 1.11 – 0.063
Lateral incisor 6 149 1.39 – 0.066
(mandible) P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.35, var(R ti) 0.28
4 117 1.11 – 0.063
5 236 1.13 – 0.555
Canine 6 193 1.27 – 0.055
(mandible) P = 0.015 0.007 NS NS
Random effect
var(Uoi) 0.28, var(R ti) 0.33

1036
J Periodontol • June 2006 Gomes-Filho, Miranda, Trindade, et al.

Table 4. (continued)
Probing Depth on Buccal Sites of Primary Teeth Using Random Coefficient Analysis for
Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD Age Gender Race

4 117 1.06 – 0.061


5 230 1.04 – 0.055
First molar 6 173 1.21 – 0.054
(mandible) P = 0.01 0.003 0.047 NS
Random effect
var(Uoi) 0.22, var(R ti) 0.39
4 116 1.48 – 0.080
5 228 1.58 – 0.071
Second molar 6 178 1.50 – 0.070
(mandible) P = 0.17 NS 0.035 NS
Random effect
var(Uoi) 0.32, var(R ti) 0.44
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.

confirmed by taking repeated measurements at the differ between subjects (children), i.e., heterogeneity
same site during the calibration sessions and in ;10% across individuals is allowed. The simplest form of ran-
of the patients (randomly selected) during the study. dom coefficient model is a model with just a random
The intraexaminer degree of agreement (k = 0.845 and intercept, where essential assumptions are that all re-
0.819) was classified as very good for PD and gingival siduals, Uoj, a random effect at the group (children)
width, respectively, according with the classification level, and Rij, a random effect at the individual (tooth)
proposed by Altman.28 Furthermore, the reproduc- level, are mutually independent and have zero means
ibility, expressed as a proportion of interexaminer given values xij of the exploratory analysis. The ran-
agreement, was 92% for PD and 89% for gingival width. dom variable Uoj and Rij have variances var(Rij) and
var(Uoj). The fraction of residual variability that can
Race Identification
be ascribed for group level is the intraclass correlation
Race was determined using criteria established by
coefficient. This parameter is the correlation between
Krieger et al.26 and Azevêdo27 (i.e., skin color, hair tex-
the Y value of two randomly drawn individuals in one
ture, head structure, and lip configuration). Skin color
randomly drawn group, controlling for variable X. The
was classified as white, clear mulatto, medium mu-
covariance model used was as follows: Yij = boj + b1age
latto, dark mulatto, or black. The clear, medium, and
+ b2race + b3gender + Uoj + Rij, where Yij is the gingival
dark mulatto classifications were lumped together in
width or PD response for children j, j = 1,2. . ., n at the ith
a single category of mulatto to simplify the statistical
tooth, and i = 1,2; boj is the highest average of the de-
analysis.
pendent variable (gingival width or PD); b1, b2, and b3
Statistical Analysis are the fixed coefficients for the covariables age, race,
The recorded data were tabulated for statistical anal- and gender; age is the covariable dummy; race is the
ysis. Gingival width and PD measurements were ana- covariable dummy; gender is the dichotomous cova-
lyzed using a statistical program.† The Student t test riable; Uoj is the random effect at the children level;
was used to evaluate the statistical significance of and Rij is the random effect at the tooth level.
differences in mean values in symmetrical primary
teeth.29 The means of the three buccal PD measure- RESULTS
ments were determined, as well as those of the three Table 1 shows gingival width measurements on buc-
lingual measurements. cal surfaces of the maxillary teeth using random coef-
Random coefficient analysis was used to evaluate ficient analysis for ages 4, 5, and 6 years, adjusted by
the effect of age, gender, and race on gingival width gender and race. There was an increase in the gingival
and PD29,30 using another statistical program.‡
The basic idea behind the use of random coefficient † Excel 2000, Microsoft, Seattle, WA.
analysis is that the regression coefficient is allowed to ‡ STATA v.9.0, College Station, TX.

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Gingival Width and Probing Depth in Primary Teeth Volume 77 • Number 6

Table 5.
Probing Depth on Lingual Sites of Primary Teeth Using Random Coefficient Analysis for
Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD (mm) Age Gender Race

4 112 1.49 – 0.930


5 221 1.65 – 0.0082
Central incisor 6 140 1.71 – 0.0850
(maxilla) P = 0.11 0.05 0.03 NS
Random effect
var(Uoi) 0.47, var(R ti) 0.31
4 115 1.38 – 0.080
5 232 1.55 – 0.070
Lateral incisor 6 177 1.62 – 0.070
(maxilla) P = 0.0031 0.006 0.04 NS
Random effect
var(Uoi) 0.37, var(R ti) 0.38
4 120 1.29 – 0.072
5 238 1.47 – 0.063
Canine 6 193 1.55 – 0.063
(maxilla) P = 0.000 0.001 0.0002 NS
Random effect
var(Uoi) 0.21, var(R ti) 0.50
4 122 1.44 – 0.083
5 235 1.56 – 0.073
6 186 1.63 – 0.073
First molar P = 0.15 NS NS NS
(maxilla) Random effect
var(Uoi) 0.40, var(R ti) 0.39
4 119 1.65 – 0.075
5 234 1.77 – 0.066
6 189 1.77 – 0.065
Second molar P = 0.009 NS 0.003 NS
(maxilla) Random effect
var(Uoi) 0.34, var(R ti) 0.36
4 115 1.03 – 0.910
5 188 1.23 – 0.085
Central incisor 6 72 1.56 – 0.100
(mandible) P = 0.000 0.000 0.015 NS
Random effect
var(Uoi) 0.43, var(R ti) 0.27
4 119 1.11 – 0.077
5 224 1.28 – 0.069
Lateral incisor 6 149 1.47 – 0.071
(mandible) P = 0.000 0.000 0.032 NS
Random effect
var(Uoi) 0.37, var(R ti) 0.33
4 117 1.14 – 0.075
5 236 1.27 – 0.065
Canine 6 193 1.49 – 0.064
(mandible) P = 0.000 0.000 0.0038 NS
Random effect
var(Uoi) 0.34, var(R ti) 0.35

1038
J Periodontol • June 2006 Gomes-Filho, Miranda, Trindade, et al.

Table 5. (continued)
Probing Depth on Lingual Sites of Primary Teeth Using Random Coefficient Analysis for
Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD (mm) Age Gender Race

4 117 1.72 – 0.074


5 230 1.82 – 0.066
First molar 6 173 1.86 – 0.065
(mandible) P = 0.064 NS NS NS
Random effect
var(Uoi) 0.32, var(R ti) 0.39
4 116 1.93 – 0.079
5 228 2.08 – 0.070
Second molar 6 178 2.03 – 0.069
(mandible) P = 0.425 NS NS NS
Random effect
var(Uoi) 0.36, var(R ti) 0.38
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.

width based on age from 4 to 6 years. For example, the molars. The global Wald test and P values illustrate the
lateral incisor gingival width (mean – SD) at 4 years existence of a linear model among the study variables
old was 4.53 – 0.16 mm; at 5 years old, 4.89 – 0.14 with statistically significant results (P £0.05), except
mm; and at 6 years old, 5.26 – 0.16 mm. The global for second molars. In agreement with the model terms
Wald test and P values illustrate a linear model among of analysis, the age variable showed statistical signifi-
the study variables, with statistically significant results cance in teeth that demonstrated the existence of the
(P £0.05), except for the central incisor. In agreement linear model. Gingival width (mean – SD) ranged from
with the model terms, the age variable showed statis- 2.95 – 0.15 mm to 6.16 – 0.20 mm.
tical significance in teeth that demonstrated the exis- Tables 4 and 5 show mean values of PD on buccal
tence of the linear model. The other terms of the model and lingual sites, respectively, of primary teeth using
(gender and race) did not demonstrate any statistical the random coefficient analysis for ages 4, 5, and 6
significance. Gingival width (mean – SD) ranged from years, adjusted by gender and race. In the majority
3.18 – 0.12 mm to 5.38 – 0.19 mm. of teeth, there was an increase in the PD (mean –
Table 2 shows gingival width measurements on SD) as age increased from 4 to 6 years. For example,
buccal surfaces of the mandibular teeth using random in Table 4, the upper central incisor on the buccal
coefficient analysis for ages 4, 5, and 6 years, adjusted side (mean – SD) at 4 years old was 1.26 – 0.10
by gender and race. The global Wald test and P val- mm; at 5 years, 1.44 – 0.09 mm; and at 6 years,
ues illustrate a linear model among the study vari- 1.55 – 0.09 mm. This tendency toward deeper PDs
ables, with statistically significant results (P £0.05). as age increased was also observed in the other teeth.
In agreement with the model terms, the age variable In addition, the global Wald test and P values in the
showed statistical significance in all teeth, whereas buccal sites showed the existence of a linear model
race showed a statistically significant difference for among the study variables in the majority of teeth with
the first molar only. An increase in the gingival width statistically significant results (P £0.05). In agreement
mean based on an increase of age from 4 to 6 years with the model terms, the age variable showed statis-
was also observed. Gingival width (mean – SD) ranged tical significance in the majority of teeth and was re-
from 3.35 – 0.09 mm to 5.43 – 0.12 mm. sponsible for the existence of the linear model.
Gingival width measurements for lingual surfaces However, gender and race models did not demon-
of the mandibular teeth are shown in Table 3, using strate statistical significance in the majority of teeth.
random coefficient analysis for ages 4, 5, and 6 years PD (mean – SD) ranged from 1.04 – 0.09 mm to
adjusted by gender and race. In the majority of teeth, 1.65 – 0.06 mm.
there was an increase in the gingival width (mean – SD) Table 5 shows PD measurements at the lingual sites
as age increased from 4 to 6 years, except for second of teeth. The global Wald test and P values showed the

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Gingival Width and Probing Depth in Primary Teeth Volume 77 • Number 6

existence of a linear model among the study variables Many investigations, including this one, present the
in all the teeth with statistically significant results gingival width and PD according to maxillary or man-
(P £0.05), except for the upper central incisor and first dibular tooth type.7-17,25 In the present study, the
molar and lower first and second molars. In agreement Student t test used to evaluate the median values in
with the model terms, the age variable showed statis- the symmetrical primary teeth did not show statistical
tical significance for the majority of teeth, except the significance among the measurements for most of
lower second molars. The gender variable showed the analyses.
statistical significance in 70% of teeth. However, the To the best of our knowledge, this is the first study to
model term of race did not demonstrate statistical sig- investigate both gingival width and PD in primary teeth
nificance. PD (mean – SD) ranged from 1.03 – 0.91 in conjunction with the variables of age, gender, and
mm to 2.08 – 0.07 mm. race. Furthermore, the statistical analysis used (the
random coefficient analysis) allowed the heterogene-
ity across children to differ, established the associa-
tion between the dependent and independent study
DISCUSSION variables, and confirmed the relationship among the
The existence of periodontal diseases in children, both age, gender, race, and two clinical parameters.
gingivitis and periodontitis, is well documented and
established.31-37 An experimental gingivitis study Gingival Width
comparing six children (aged 4 to 5 years) with six The gingival width of 7,351 surfaces in 4,958 teeth
dental students (age 23 to 29 years) showed that from 300 children in this study agrees with earlier
the children developed gingivitis less readily than data. Most earlier studies7,9,14,17,40,41 confirm that
the adults. Children developed significantly less bleed- gingival width on buccal surfaces of both arches de-
ing units (8.6% versus 43.9%) at day 21 in teeth with creases from anterior to posterior positions. In the pres-
the same plaque index.31 Plaque-induced gingivitis is ent study, gingival width was highest on maxillary
prevalent in children and adolescents.32,33 Typical upper central incisors and lowest on maxillary first
features of this form of gingivitis include gingival red- molars (Table 1). Gingival width on mandibular lin-
ness, swelling, loss of contour, marginal bleeding, and gual surfaces increased from anterior to posterior po-
pseudopockets in the absence of bone loss, all of sitions (highest value: second molars; lowest values:
which are reversible following appropriate therapy. central incisors; Table 3).
Page et al.34 first described prepubertal periodontitis An increase in gingival width measurement on buc-
as a distinct clinical entity, defining it as usually occur- cal surfaces of both arches was observed as age in-
ring during or soon after the eruption of the primary creased from 4 to 6 years. The age variable was the
teeth. Both familial clustering of prepubertal peri- model term responsible for the linear model in evalu-
odontitis and a higher incidence in girls have been atedteeth(Tables1and2).However,therace(P £0.05)
documented.34-37 Watanabe38 reviewed diagnostic variable was also responsible for the linear model in
criteria, pathogenesis, and differential diagnosis of pre- the lower first molar. Other studies7,9,14,17,24,25 confirm
pubertal periodontitis, concluding that there is no asso- that the general increase in gingival width is correlated
ciation with systemic conditions (i.e., neutropenia) with an increase in age.
and the prevalence ranging from 0.84% to 26.9%. An increase in gingival width on lingual surfaces
An important variable considered in this study was of mandibular primary teeth was observed as age in-
the gingival condition of the tooth. The children who creased from 4 to 6 years. Once more, the age variable
participated were in an oral health program for 3 years, was the model term responsible for the linear model in
which included weekly motivation, fluoride applica- all teeth. Consequently, in agreement with the results of
tion, and clinical visits with scaling, restorations, and the present study (Tables 1 through 3) and those of
extractions. Based on the low bleeding on probing previously published studies,7,9,14,17,24,25 the age var-
score39 (4.41% of sites), general gingival conditions iable has a significant influence on the gingival width
were very healthy. The data also showed that all teeth of lingual and buccal surfaces. A specific evaluation
except the lower central incisors had similar values in of the gingival width on the lingual surfaces of pri-
7,351 gingival width sites (Tables 1 through 3) and in mary teeth was reported only by the Gomes-Filho
30,528 PD sites (Tables 4 and 5) of all age groups et al. studies.40,41
and both genders. The lower central incisors pre- The data from this study were obtained from a pop-
sented with lower number evaluations in children at ulation representing a group of Brazilian children with
6 years old, with 70 and 64 evaluated teeth/surfaces specific ethnic features.26,27 The mean gingival width
(Tables 3 and 4, respectively). This pattern is consistent values on the lingual and buccal surfaces ranged from
with the loss of primary dentition, which begins 2.95 – 0.15 mm to 6.16 – 0.20 mm. The standard
around 6 years with the lower central incisors. deviation values presented in this study showed an

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J Periodontol • June 2006 Gomes-Filho, Miranda, Trindade, et al.

interindividual variation. It is suggested that further in- gender; furthermore, there is no relation between race
vestigation should be done to compare the gingival and this measurement in the studied population.
width in primary teeth with permanent ones.
ACKNOWLEDGMENTS
Probing Depth The authors thank Dr. Neil Blumenthal, University of
The mean gingival PD values of 30,528 sites of 5,088 Illinois at Chicago, Chicago, Illinois, for help during
teeth of 300 children evaluated in this study agree the preparation of this manuscript and Drs. Eliane
with earlier studies.10-16 In the majority of buccal Azevêdo and Eneida Moraes Marcı́lio Cerqueira, Feira
and lingual sites measured in the present study, mean de Santana State University, for assisting with gather-
values increased from anterior to posterior positions ing data and making the development of this research
in both arches. The mean PD values for all teeth exam- possible.
ined showed the highest mean value in lingual sites of
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