Periodontal disease is common in Chinese adolescents. There is little information about the effect of different altitudes on gingival health. This study aimed to investigate the gingival status at different altitudes and to identify relative factors that affect adolescents' gingival status. A total of 1033 adolescents aged 12–14 years were included in this cross-sectional study in Ganzi (plateau, 1400 m, 2560 m, 3300 m) and Suining (plain, 300 m). Gingival status was assessed by the presence of gingival bleeding on probing (BOP) and dental calculus (DC). Demographic variables, socioeconomic status, dairy habits and oral health-related knowledge, attitudes and behaviors were obtained via questionnaire. Univariate and multivariate binary logistic regression analyses were performed to identify potential relative factors. A total of 64.09% and 77.15% of adolescents had BOP and DC, respectively. The prevalence rates of BOP and DC were higher in the plateau than the plain (P < 0.05). After adjusting for all other factors and interaction terms, residence altitudes of 2560 m [300 m as reference: P < 0.001, odds ratio (OR) = 4.072] and 3300 m (300 m as reference: P = 0.002, OR = 4.053) were significant relative factors of BOP, and an altitude of 2560 m (300 m as reference: P = 0.001, OR = 3.866, 1400 m as reference: P = 0.001, OR = 3.944) was an important relative factor of DC. Gingival bleeding and calculus deposits were common at different altitudes. High altitude was a significant relative factor of gingival bleeding and calculus deposits.
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The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.
Akcali, A., & Lang, N. P. (2018). Dental calculus: the calcified biofilm and its role in disease development. Periodontology 2000, 76(1), 109–115. https://doi.org/10.1111/prd.12151.
Betz, M. E., Valley, M. A., Lowenstein, S. R., Hedegaard, H., Thomas, D., Stallones, L., et al. (2011). Elevated suicide rates at high altitude: Sociodemographic and health issues may be to blame. Suicide & Life-Threatening Behavior, 41(5), 562–573. https://doi.org/10.1111/j.1943-278X.2011.00054.x.
Botero, J. E., Rosing, C. K., Duque, A., Jaramillo, A., & Contreras, A. (2015). Periodontal disease in children and adolescents of Latin America. Periodontology 2000, 67(1), 34–57. https://doi.org/10.1111/prd.12072.
Cao, C.-F. (2013). Prevalences of periodontal diseases and dental caries in China: re-analysis of the data from the Third National Epidemiological Survey on Oral Health. Zhonghua kou qiang yi xue za zhi = Zhonghua kouqiang yixue zazhi = Chinese Journal of Stomatology, 48(5), 257–259. https://doi.org/10.3760/cma.j.issn.1002-0098.2013.05.001.
Carmo, C. D. S., Ribeiro, M. R. C., Teixeira, J. X. P., Alves, C. M. C., Franco, M. M., Franca, A., et al. (2018). Added sugar consumption and chronic oral disease burden among adolescents in Brazil. Journal of Dental Research, 97(5), 508–514. https://doi.org/10.1177/0022034517745326.
Chaitra, T. R., Manuja, N., Sinha, A. A., & Kulkarni, A. U. (2012). Hormonal effect on gingiva: Pubertal gingivitis. BMJ Case Reports. https://doi.org/10.1136/bcr.2012.006193.
Chen, H., Zhang, R., Cheng, R., Xu, T., Zhang, T., Hong, X., et al. (2020). Gingival bleeding and calculus among 12-year-old Chinese adolescents: A multilevel analysis. Bmc Oral Health, 20(1), 147. https://doi.org/10.1186/s12903-020-01125-3.
Chen, J., Wu, X., He, Y., Li, S., Deng, Y., Chen, J., et al. (2018a). A retrospective analysis of the clinical features of inpatients with epilepsy in the Ganzi Tibetan Autonomous Prefecture. Frontiers in Neurology, 9, 891. https://doi.org/10.3389/fneur.2018.00891.
Chen, J., Zhao, H., Deng, Y., & Tao, L. (2018b). The review of geography. In J. Chen (Ed.), Sichuan Tongji Nian Jian 2018. Chengdu: Si Chuan Nian Jian She.
Cheng, R., Choudhury, D., Liu, C., Billet, S., Hu, T., & Bhowmick, N. A. (2015). Gingival fibroblasts resist apoptosis in response to oxidative stress in a model of periodontal diseases. Cell Death Discovery, 1, 15046. https://doi.org/10.1038/cddiscovery.2015.46.
Cheng, R., Liu, W., Zhang, R., Feng, Y., Bhowmick, N. A., & Hu, T. (2017). Porphyromonas gingivalis-derived lipopolysaccharide combines hypoxia to induce Caspase-1 activation in periodontitis. Frontiers in Cellular and Infection Microbiology, 7, 474. https://doi.org/10.3389/fcimb.2017.00474.
Cheng, W., Ding, Y., Hu, P., & Liang, W. (2015). Resident population (year-end), birth rate, death rate, natural growth rate, urbanization rate and population density by region. In J. Xiong (Ed.), Sichuan Tongji Nian Jian 2016. Beijing: Zhongguo Tongji Chuban She.
Du, A., Zhang, H., Chen, C., Zhang, F., Liu, X., Zhang, Z., et al. (2019). Oral health of 12-year-old children in Jilin province, China: A population-based epidemiological survey. Medicine (Baltimore), 98(51), e18463. https://doi.org/10.1097/MD.0000000000018463.
Elias-Boneta, A. R., Ramirez, K., Rivas-Tumanyan, S., Murillo, M., & Toro, M. J. (2018). Prevalence of gingivitis and calculus in 12-year-old Puerto Ricans: a cross-sectional study. BMC Oral Health, 18(1), 13. https://doi.org/10.1186/s12903-017-0471-5.
Fitzgerald, R. S. (2018). O2/CO2: Biological detection to homeostatic control. Advances in Experimental Medicine and Biology, 1071, 1–12. https://doi.org/10.1007/978-3-319-91137-3_1.
Golz, L., Memmert, S., Rath-Deschner, B., Jager, A., Appel, T., Baumgarten, G., et al. (2015). Hypoxia and P. gingivalis synergistically induce HIF-1 and NF-kappaB activation in PDL cells and periodontal diseases. Mediators of Inflammation, 2015, 438085. https://doi.org/10.1155/2015/438085.
Grocott, M. P., Martin, D. S., Levett, D. Z., McMorrow, R., Windsor, J., Montgomery, H. E., et al. (2009). Arterial blood gases and oxygen content in climbers on Mount Everest. New England Journal of Medicine, 360(2), 140–149. https://doi.org/10.1056/NEJMoa0801581.
Haas, A. N., Prado, R., Rios, F. S., Costa, R. D. S. A., Angst, P. D. M., Moura, M. D. S., et al. (2019). Occurrence and predictors of gingivitis and supragingival calculus in a population of Brazilian adults. Brazilian Oral Research, 33, e036. https://doi.org/10.1590/1807-3107bor-2019.vol33.0036.
Hajishengallis, G. (2014). Immunomicrobial pathogenesis of periodontitis: Keystones, pathobionts, and host response. Trends in Immunology, 35(1), 3–11. https://doi.org/10.1016/j.it.2013.09.001.
Hazen, S. P. (1995). Supragingival dental calculus. Periodontology, 2000(8), 125–136.
Horscroft, J. A., Kotwica, A. O., Laner, V., West, J. A., Hennis, P. J., Levett, D. Z. H., et al. (2017). Metabolic basis to Sherpa altitude adaptation. Proceedings of the National Academy of Sciences, 114(24), 6382–6387. https://doi.org/10.1073/pnas.1700527114.
Julian, C. G., & Moore, L. G. (2019). Human genetic adaptation to high altitude: Evidence from the Andes. Genes (Basel), 10(2), 150. https://doi.org/10.3390/genes10020150.
Kupper, T., Hettlich, M., Horz, H. P., Lechner, K., Scharfenberg, C., Conrads, G., et al. (2014). Dental problems and emergencies of trekkers–epidemiology and prevention. Results of the ADEMED Expedition 2008. High Altitude Medicine & Biology, 15(1), 39–45. https://doi.org/10.1089/ham.2013.1108.
Liu, L., Zhang, Y., Wu, W., He, M., Lu, Z., Zhang, K., et al. (2019). Oral health status among visually impaired schoolchildren in Northeast China. BMC Oral Health, 19(1), 63. https://doi.org/10.1186/s12903-019-0752-2.
Liu, Y., Wang, Q., Li, T., & Su, Z. (2007). An epidemiological study of periodontal diseases among the conscripts garrisoned inTibet. Yati Yasui Yazhou Bing Xue Zazhi, 17(5), 282–285. https://doi.org/10.15956/j.cnki.
Luks, A. M., Swenson, E. R., & Bartsch, P. (2017). Acute high-altitude sickness. European Respiratory Review, 26(143), 160096. https://doi.org/10.1183/16000617.0096-2016.
Luo, P., Zhang, X., Cheng, J., & Sun, Q. (2019). Modeling population density using a new index derived from multi-sensor image data. Remote Sensing, 11(22), 2620. https://doi.org/10.3390/rs11222620.
Luo, Y., Luo, R., Li, W., Huang, J., Zhou, Q., & Gao, Y. (2012). High altitude medicine education in China: Exploring a new medical education reform. High Altitude Medicine & Biology, 13(1), 57–59. https://doi.org/10.1089/ham.2011.1090.
Moore, L. G. (2017). Measuring high-altitude adaptation. Journal of Applied Physiology, 123(5), 1371–1385. https://doi.org/10.1152/japplphysiol.00321.2017.
Murakami, K., Kondo, N., Ohkubo, T., & Hashimoto, H. (2016). The effect of fathers’ and mothers’ educational level on adult oral health in Japan. Community Dentistry and Oral Epidemiology, 44(3), 283–291. https://doi.org/10.1111/cdoe.12216.
Oral health surveys: basic methods (2013). (5 ed.).
Peres, M. A., Macpherson, L. M. D., Weyant, R. J., Daly, B., Venturelli, R., Mathur, M. R., et al. (2019). Oral diseases: A global public health challenge. Lancet, 394(10194), 249–260. https://doi.org/10.1016/S0140-6736(19)31146-8.
Poschl, U., & Shiraiwa, M. (2015). Multiphase chemistry at the atmosphere-biosphere interface influencing climate and public health in the anthropocene. Chemical Reviews, 115(10), 4440–4475. https://doi.org/10.1021/cr500487s.
Poulsen, V., Ingerslev, H. J., & Kirkegaard, K. (2017). Elective embryo transfers on Day 6 reduce implantation compared with transfers on Day 5. Human Reproduction, 32(6), 1238–1243. https://doi.org/10.1093/humrep/dex059.
Pu, D., Liu, L., Song, Y., & Zhang, H. (2009). An epidemiological study of periodontal diseases among the garrison troops at different altitudes. Yati Yasui Yazhou Bing Xue Zazhi, 19(1), 35–38.
Qin, Y., Zhang, R., Yuan, B., Xu, T., Chen, H., Yang, Y., et al. (2019). Structural equation modelling for associated factors with dental caries among 3–5-year-old children: A cross-sectional study. BMC Oral Health, 19(1), 102. https://doi.org/10.1186/s12903-019-0787-4.
Shao, R., Hu, T., Zhong, Y. S., Li, X., Gao, Y. B., Wang, Y. F., et al. (2018). Socio-demographic factors, dental status and health-related behaviors associated with geriatric oral health-related quality of life in Southwestern China. Health and Quality of Life Outcomes, 16, ARTN98. https://doi.org/10.1186/s12955-018-0925-8.
Shu, Z., & Li, C. (2017). Suining statistical yearbook 2017 (1st ed.). Sichuan: Suining Shi Tongji Ju.
Shu, Z., & Wang, L. (2016). Suining statistical yearbook 2016 (1st ed.). Sichuan: Suining Shi Tongji Ju.
Soria, R., Egger, M., Scherrer, U., Bender, N., & Rimoldi, S. F. (2016). Pulmonary artery pressure and arterial oxygen saturation in people living at high or low altitude: Systematic review and meta-analysis. Journal of Applied Physiology (1985), 121(5), 1151–1159. https://doi.org/10.1152/japplphysiol.00394.2016.
Soria, R., Julian, C. G., Vargas, E., Moore, L. G., & Giussani, D. A. (2013). Graduated effects of high-altitude hypoxia and highland ancestry on birth size. Pediatric Research, 74(6), 633–638. https://doi.org/10.1038/pr.2013.150.
Stephens, M. B., Wiedemer, J. P., & Kushner, G. M. (2018). Dental problems in primary care. American Family Physician, 98(11), 654–660.
Terrizzi, A. R., Conti, M. I., Martinez, M. P., & Fernandez-Solari, J. (2018). The process of acclimation to chronic hypoxia leads to submandibular gland and periodontal alterations: An insight on the role of inflammatory mediators. Mediators of Inflammation, 2018, 6794508. https://doi.org/10.1155/2018/6794508.
Terrizzi, A. R., Fernandez-Solari, J., Lee, C. M., Conti, M. I., & Martinez, M. P. (2016). Deleterious effect of chronic continuous hypoxia on oral health. Archives of Oral Biology, 72, 1–7. https://doi.org/10.1016/j.archoralbio.2016.08.006.
Trentini, P., Ferrante, M., Dolci, M., Ciavarelli, L., Tondi, A., & Spoto, G. (2007). Enzymatic analysis of the gingival crevicular fluid in hypoxia of high altitude (Everest). International Journal of Immunopathology and Pharmacology, 20(1 Suppl 1), 1–4.
Vadiakas, G., Oulis, C. J., Tsinidou, K., Mamai-Homata, E., & Polychronopoulou, A. (2012). Oral hygiene and periodontal status of 12 and 15-year-old Greek adolescents. A national pathfinder survey. European Archives of Paediatric Dentistry, 13(1), 11–20.
Wang, L., Cheng, L., Yuan, B., Hong, X., & Hu, T. (2017). Association between socio-economic status and dental caries in elderly people in Sichuan Province, China: A cross-sectional study. British Medical Journal Open, 7(9), e016557. https://doi.org/10.1136/bmjopen-2017-016557.
Wang, Y., Wang, Y., Feng, Y., Tian, Y., Jiang, C., & Gao, L. (2010). Normal reference values of parameters in saliva of healthy servicemen at high altitude areas. Jun Yi Jin Xiu Xue Xiao Xue Bao, 31(12), 1173–1174.
West, J. B. (2015). A strategy for oxygen conditioning at high altitude: Comparison with air conditioning. Journal of Applied Physiology (1985), 119(6), 719–723. https://doi.org/10.1152/japplphysiol.00421.2015.
West, J. B. (2016). Oxygen conditioning: A new technique for improving living and working at high altitude. Physiology, 31(3), 216–222. https://doi.org/10.1152/physiol.00057.2015.
Xiao, X., Li, Y., Zhang, G., Gao, Y., Kong, Y., Liu, M., et al. (2012). Detection of bacterial diversity in rat’s periodontitis model under imitational altitude hypoxia environment. Archives of Oral Biology, 57(1), 23–29. https://doi.org/10.1016/j.archoralbio.2011.07.005.
Xu, W., Yu, W., Jing, S., Zhang, G., & Huang, J. (2013). Debris flow susceptibility assessment by GIS and information value model in a large-scale region, Sichuan Province (China). Natural Hazards, 2013(65), 1379–1392. https://doi.org/10.1007/s11069-012-0414-z.
Yin, W., Yang, Y. M., Chen, H., Li, X., Wang, Z., Cheng, L., et al. (2017). Oral health status in Sichuan Province: findings from the oral health survey of Sichuan, 2015–2016. International Journal of Oral Science, 9(1), 10–15. https://doi.org/10.1038/ijos.2017.6.
Zhang, Q., Li, Z., Wang, C., Shen, T., Yang, Y., Chotivichien, S., et al. (2014a). Prevalence and predictors for periodontitis among adults in China, 2010. Global Health Action, 7, 24503. https://doi.org/10.3402/gha.v7.24503.
Zhang, R., Cheng, L., Zhang, T., Xu, T., Li, M., Yin, W., et al. (2018). Brick tea consumption is a risk factor for dental caries and dental fluorosis among 12-year-old Tibetan children in Ganzi. Environmental Geochemistry and Health. https://doi.org/10.1007/s10653-018-0216-7.
Zhang, S., Liu, J., Lo, E. C., & Chu, C. H. (2014b). Dental and periodontal status of 12-year-old Bulang children in China. BMC Oral Health, 14, 32. https://doi.org/10.1186/1472-6831-14-32.
Zhang, S., Xu, B., Liu, J., Lo, E. C., & Chu, C. H. (2015). Dental and periodontal status of 12-year-old Dai school children in Yunnan Province, China: A cross-sectional study. BMC Oral Health, 15(1), 117. https://doi.org/10.1186/s12903-015-0106-7.
Zhang, Z., Liang, N., & Tian, G. (2012). A survey of periodontal healthy status of middle school Trukish students in Huzhu area of Qinghai Province at high altitude. Shiyong Kouqiang Yixue Zazhi, 28(5), 638–641.
This survey was funded by grants from National Natural Science Foundation of China (81970948), a follow-up investigation of the 4th National Oral Health Epidemiological Survey and Key Research and Development Program of China of Sichuan Province (20ZDYF3012). We appreciate Ganzi Tibetan Autonomous Prefecture People’s Hospital for their support and thank the technical assistance provided by the Sichuan Centre for Disease Control and Prevention, survey team from the West China Hospital of Stomatology, Sichuan University, P. R. China.
This survey was funded by grants from National Natural Science Foundation of China (81970948), The follow up investigation of the 4th National Oral Health Epidemiological Survey and Key Research and Development Program of China of Sichuan Province (20ZDYF3012).
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The authors declare that they have no conflict of interest.
This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by Stomatological Ethics Committee of the Chinese Stomatological Association (Approval No. 2014-003) and Research Ethics Committee of West China Hospital of stomatology, Sichuan University (WCHSIRB-OT2016-077).
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Wu, Z., Zhang, R., Cheng, L. et al. The correlation of altitude with gingival status among adolescents in western China: a cross-sectional study. Environ Geochem Health (2021). https://doi.org/10.1007/s10653-021-00812-6
- Gingival bleeding
- Calculus deposit
- Cross-sectional study