Prevalence of periodontal diseases and correlations with risk factors among a sample of Yemeni people: cross-sectional study

ALHAJJ, Wadhah Abdulnasser; ALHAJ, Nader Jamal; BASMAIL, Fatma Salem; SALEH, Rana Ayed

doi:10.4322/bds.2026.e4747

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Original Article • Braz. Dent. Sci. 29 • 2026 • https://doi.org/10.4322/bds.2026.e4747 linkcopy

Prevalence of periodontal diseases and correlations with risk factors among a sample of Yemeni people: cross-sectional study

Prevalência de doenças periodontais e correlações com fatores de risco em uma amostra da população Iemenita: estudo transversal

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective In Yemen, several studies have investigated the prevalence of periodontal diseases; however, most were geographically restricted or assessed fewer clinical parameters and risk factors. Therefore, the objective of this study was to evaluate the prevalence and severity of periodontal diseases among the Yemeni population and their relationship to various risk factors.

Material and Methods A total of 405 Yemeni adults attending the polyclinics of Civilization, Mahweet, and Aden Universities, as well as private clinics, from March 2024 to August 2024, were included in this study. Data were collected using a questionnaire that covered sociodemographic information, oral hygiene practices, and harmful habits, along with a clinical examination. All data were subsequently entered for statistical analysis.

Results The results showed that the prevalence of biofilm-induced gingivitis was 51.6%, while periodontitis was more prevalent, affecting 79.3% of the population. Both gingivitis and periodontitis were more common in males and in participants aged ≥35 years. Regular daily tooth brushing, especially twice daily, was significantly associated with lower rates of gingivitis and periodontitis (p < 0.001). In contrast, gingivitis and periodontitis were more frequent among khat chewers, particularly those who chewed daily for more than 20 years. Similarly, smokers, especially those who smoked for over 20 years, showed a significantly higher prevalence of gingivitis and periodontitis (p < 0.001).

Conclusion Periodontitis is more prevalent than biofilm-induced gingivitis among the Yemeni population. Both conditions are more common in males and in individuals aged ≥35 years. Lack of tooth brushing, long-term daily khat chewing, and long-term smoking (>20 years) were identified as the most strongly associated risk factors.

KEYWORDS:
Khat; Periodontal diseases; Prevalence; Risk factors; Yemen

Parameters		Frequency	Percentage
Age	> 35	215	53.1
Age	≤ 35	190	46.9
Gender	Male	201	49.6
Gender	Female	204	50.4
Occupation	house wife	69	17.0
	Employee	34	8.4
	Farmer	29	7.2
	Worker	18	4.4
	Teacher	29	7.2
	Doctor	29	7.2
	Engineer	15	3.7
	Student	133	32.8
	Other	29	7.2
	unemployed	20	4.9
Khat chewing	No	151	37.3
	Yes	236	58.3
	Previous	18	4.4
Khat chewing frequency	Once daily	119	50.4
	Twice daily	15	6.4
	Three times daily	8	3.4
	once weekly	25	10.6
	Twice weekly	24	10.2
	Three times weekly	1	0.4
	once monthly	4	1.7
	Twice monthly	2	0.8
	Rarely	38	16.1
Khat chewing duration in years	Less than 5 years	77	32.6
	5 – 10 years	52	22
	11– 20 years	11	4.7
	More than 20 years	96	40.7
Khat chewing duration in hours	Less than 3 hours	171	67.3
	3 – 5 hours	59	23.2
	6 – 10 hours	24	9.5
	More than 10 hours	0	0.0
Smoking	No	166	41.0
	Yes	229	56.5
	Previously	10	2.5
Smoking duration	Less than 5 years	183	76.6
	5 – 10 years	16	6.7
	11– 20 years	13	5.4
	More than 20 years	27	11.3
Type of smoking	Cigarette	93	38.9
	Shisha (Hookah)	65	27.2
	Water pipe (mada'a)	21	8.8
	Vape (Electronic)	13	5.4
	More than one	47	19.7
Cigarette no	Less than 10 cig.	152	63.6
	10 – 20 cig.	67	28
	More than 20 cig.	20	8.4
Tooth brushing	No	96	23.7
Tooth brushing	Yes	309	76.3
Tooth brushing	Daily	213	68.9
Tooth brushing	Not daily	96	31.1
Tooth brushing	Once daily	95	44.6
	Twice daily	117	54.9
	Three times daily	1	0.5
Interdental aids	No	192	47.4
Interdental aids	Yes	213	52.6
Interdental aids types	Dental floss	10	4.7
	Interdental brush	11	5.2
	Toothpicks	83	39
	Other	37	17.3
	more than one	72	33.8

Severity of biofilm induced gingivitis	F	%	F	%
• Healthy	196	48.4	196	48.4
• Mild	140	67	209	51.6
• Moderate	69	33
• Severe	0	0.0
Total	405	100	405	100
Severity of periodontitis	F	%	F	%
• Healthy	84	20.7	84	20.7
• Mild (Stage I)	114	35.5	321	79.3
• Moderate (Stage II)	102	31.8
• Severe (Stage III)	86	26.8
• Very Severe (Stage IV)	19	6
Total	405	100	405	100

Variables	Mean ±SD	Median
• PLI	1.7±0.67	1.7
• GI	1.3±0.64	1.2
• PBI	1.2±0.67	1.2
• CI	1.1±0.95	1
• Periodontal pockets	4.2±0.89	4

		PLI						GI
		0	1	2	3	X	p. value	0	1	2	3	X	p. value
Age	<35	0.5%	22.8%	43.7%	32.6%	0.19	0.001*	0.5%	41.9%	47.0%	10.2%	0.24	0.001*
Age	≥35	0.0%	10.0%	42.6%	47.4%	0.19	0.001*	0.0%	20.0%	60.0%	19.5%	0.24	0.001*
Gender	Male	0.0%	10.9%	33.8%	55.2%	-0.31	0.001*	0.0%	25.4%	64.2%	10.0%	-0.05	0.3
Gender	Female	0.5%	22.5%	52.5%	24.0%	-0.31	0.001*	0.5%	37.7%	42.2%	19.1%	-0.05	0.3
Occupation	House wife	0.0%	13.0%	58.0%	29.0%	-0.005	0.91	0.0%	24.6%	43.5%	31.9%	-0.20	0.001*
	Employee	0.0%	2.9%	61.8%	35.3%			0.0%	17.6%	50.0%	29.4%
	Farmer	0.0%	10.3%	10.3%	79.3%			0.0%	13.8%	75.9%	10.3%
	Worker	0.0%	0.0	27.8%	72.2%			0.0%	5.6%	83.3%	11.1%
	Teacher	3.4	10.3%	27.6%	55.2%			3.4	17.2%	69.0%	10.3%
	Doctor	0.0%	41.4%	41.4%	17.2%			0.0%	51.7%	44.8%	3.4%
	Engineer	0.0%	53.3%	40.0%	6.7%			0.0%	46.7%	33.3%	20.0%
	Student	0.0%	21.8%	47.4%	30.8%			0.0%	47.4%	47.4%	5.3%
	Other	0.0%	6.9%	27.6%	65.5%			0.0%	24.1%	55.2%	17.2%
	Unemployed	0.0%	5.0%	45.0%	50.0%			0.0%	15.0%	70.0%	15.0%
Khat chewing	No	0.7%	29.8%	51.0%	17.9%	0.32	0.001*	0.7%	51.0%	35.8%	11.9%	0.26	0.001*
	Yes	0.0%	6.8%	38.3%	54.9%	0.32	0.001*	0.0%	19.6%	64.3%	16.2%	0.26	0.001*
	Previous	0.0%	36.8%	42.1%	21.1%			0.0%	26.3%	52.6%	15.8%
Smoking	No	0.6%	27.7%	54.2%	16.9%	0.39	0.001*	0.6%	45.2%	41.6%	12.0%	0.22	0.001*
	Yes	0.0%	9.6%	34.9%	55.5%	0.39	0.001*	0.0%	23.1%	60.3%	16.6%	0.22	0.001*
	Previous	0.0%	0.0%	55.6%	44.4%			0.0%	0.0%	88.9%	11.1%
Tooth brushing	No	0.0%	11.1%	11.1%	77.8%	0.19	0.001*	0.0%	22.2%	33.3%	33.3%	0.20	0.001*
Tooth brushing	Yes	0.3%	20.4%	47.9%	31.1%	0.19	0.001*	0.3%	38.2%	51.1%	10.0%	0.20	0.001*

		Biofilm-induced gingivitis				X	p-value	Periodontitis				X	p-value
Demographic characteristics	Age group	No		Yes		14.2*	0.001*	No		Yes		43.4*	0.001*
	Age group	F	%	F	%			F	%	F	%
	• > 35	123	30.4	92	22.7			70	17.3	145	35.8
	• ≤ 35	73	18.0	117	28.9			14	3.4	175	43.2
	Gender	No		Yes		5.9*	0.015	No		Yes		43.2*	0.001*
	Gender	F	%	F	%			F	%	F	%
	• Male	85	20.9	116	28.6			16	4.0	184	45.4
	• Female	111	27.4	93	23.0			68	16.7	136	33.6
	Occupation	No		Yes		-0.15**	0.002	No		Yes		-0.25^**	0.001*
	Occupation	F	%	F	%			F	%	F	%
	• House wife	24	5.9	45	11.1			3	0.7	66	16.3
	• Employee	14	3.4	20	4.9			3	0.7	31	7.6
	• Farmer	5	1.2	24	5.9			0	0.0	29	7.2
	• Worker	4	0.10	14	3.4			0	0.0	18	4.4
	• Teacher	11	2.7	18	4.4			3	0.7	26	6.4
	• Doctor	21	5.2	8	2.0			10	2.4	18	4.4
	• Engineer	10	2.4	5	1.2			3	0.7	12	2.9
	• Student	96	23.7	37	9.1			58	14.3	75	18.5
	• Other	6	1.5	23	5.7			1	0.2	28	7.0
	• Unemployed	5	1.2	15	3.7			3	0.7	17	4.2

		Biofilm-induced gingivitis				X	p-value	Periodontitis				X	p-value
Tooth Brushing	Tooth brushing	No		Yes		28.1*	0.001*	No		Yes		34.6*	0.001*
	Tooth brushing	F	%	F	%			F	%	F	%
	• No	3	0.7	6	1.5			1	0.2	8	1.9
	• Yes	174	43.0	135	33.3			83	20.5	225	55.6
	Tooth brushing	No		Yes		47.5*	0.001*	No		Yes		50.1*	0.001*
	Tooth brushing	F	%	F	%			F	%	F	%
	• Daily	138	34.1	75	18.5			72	17.8	140	34.5
	• Not Daily	36	8.9	60	14.8			11	2.7	85	21.0
	Tooth brushing frequency	No		Yes		-0.37**	0.002	No		Yes		-0.34**	0.001*
	Tooth brushing frequency	F	%	F	%			F	%	F	%
	• Once daily	52	12.8	43	10.6			3	0.7	66	16.3
	• Twice daily	87	21.5	35	8.6			3	0.7	31	7.6
	• Three times daily	0	0.0	1	0.2
Interdental Aides	Interdental Aids	No		Yes		1.1*	0.3	No		Yes		2.2*	0.3
	Interdental Aids	F	%	F	%			F	%	F	%
	• No	88	21.7	104	25.6			36	8.9	156	38.5
	• Yes	108	26.7	104	25.6			48	11.8	163	40.2
	Interdental Aids use type	No		Yes		-0.4^**	0.3	No		Yes		-0.5**	0.3
	Interdental Aids use type	F	%	F	%			F	%	F	%
	• Dental floss	6	1.5	4	0.9			4	0.9	6	1.5
	• Interdental brush	3	0.7	8	1.9			3	0.7	8	1.9
	• Toothpicks	24	5.9	59	14.5			2	0.5	80	19.7
	• Other	19	4.7	18	4.4			5	1.2	32	7.9
	• More than one	56	13.8	16	3.9			34	8.4	38	9.4

		Gingivitis		X	p-value	Periodontitis		X	p-value
Oral Habits	Khat chewing	No	Yes	0.08**	0.09	No	Yes	0.5**	0.001*
	• No	85	66			77	74
	• Yes	97	138			5	229
	• Previous	14	5			2	17
	Khat chewing F	No	Yes	0.0*	0.47	No	Yes	0.4**	0.001*
	• Once daily	46	73			1	118
	• Twice daily	3	12			0	15
	• Three times daily	0	8			0	8
	• Once weekly	10	15			1	24
	• Twice weekly	15	9			3	21
	• Three times weekly	0	1			0	1
	• Once monthly	4	0			1	3
	• Twice monthly	1	1			0	2
	• Rarely	19	19			0	37
	Khat chewing	No	Yes	10.2	0.1	No	Yes	0.4	0.001*
	• Less than 5 years	41	36			1	76
	• 5 – 10 years	19	33			2	50
	• 11– 20 years	4	7			0	10
	• More than 20 years	34	62			3	93
	Khat chewing	No	Yes	0.06	0.2	No	Yes	0.4	0.001*
	• Less than 3 hours	74	97			3	167
	• 3 – 5 hours	34	25			4	55
	• 6 – 10 hours	3	21			0	24
	Khat chewing side	No	Yes	0.2	0.001*	No	Yes	0.4	0.001*
	• Right	14	7			2	19
	• Left	54	54			2	106
	• Both	27	58			2	82
	Smoking	No	Yes	0.2**	0.001*	No	Yes	0.2**	0.001*
	• No	105	61			49	116
	• Yes	85	144			34	195
	• Previous	5	4			0	9
	Smoking duration	No	Yes	0.2**	0.001*	No	Yes	0.2**	0.001*
	• Less than 5 years	81	102			34	149
	• 5 – 10 years	3	13			0	16
	• 11– 20 years	2	11			0	13
	• More than 20 years	5	22			1	26
	Type of Smoking	No	Yes	0.2**	0.001*	No	Yes	0.2**	0.001*
	• Cigarette	27	66			6	87
	• Shisha (Hookah)	36	29			24	41
	• Water pipe (mada'a)	7	14			1	20
	• Vape (Electronic)	5	8			0	13
	• More than one	16	28			4	40
	Number of cigerettes	No	Yes	0.2**	0.001*	No	Yes	0.2**	0.001*
	• Less than 10 cig.	69	83			30	122
	• 10 – 20 cig.	20	47			4	63
	• More than 20 cig.	1	16			0	17

		Pockets distribution				GR				FI
		Localized	Generalized	X	p. value	No	Yes	X	p. value	No	Yes	X	p. value
Age	<35	28.8%	14.0%	14.4	0.001*	83.7%	16.3%	20.4	0.001*	78.6%	21.4%	8.3	0.004
Age	≥35	41.1%	20.5%	14.4	0.001*	64.2%	35.8%	20.4	0.001*	65.8%	34.2%	8.3	0.004
Gender	Male	38.3%	19.4%	6	0.04	64.2%	35.8%	23.1	0.001*	62.2%	37.8%	22.1	0.001*
Gender	Female	30.9%	14.7%	6	0.04	84.8%	15.2%	23.1	0.001*	82.8%	17.2%	22.1	0.001*
Occupation	House Wife	43.5%	21.7%	-.179	0.001*	75.4%	24.6%	-.126	0.01	71.0%	29.0%	-.091	0.06
	Employee	26.5%	32.4%			64.7%	35.3%			70.6%	29.4%
	Farmer	51.7%	31.0%			27.6%	72.4%			41.4%	58.6%
	Worker	38.9%	38.9%			50.0%	50.0%			72.2%	27.8%
	Teacher	34.5%	27.6%			65.5%	34.5%			69.0%	31.0%
	Doctor	17.2%	10.3%			86.2%	13.8%			75.9%	24.1%
	Engineer	33.3%				93.3%	6.7%			73.3%	26.7%
	Student	24.8%	3.0%			94.0%	6.0%			82.0%	18.0%
	Other	55.2%	24.1%			58.6%	41.4%			69.0%	31.0%
	Unemployed	50.0%	25.0%			55.0%	45.0%			70.0%	30.0%

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[TFN1] ^*
in p-value column means a statistically significant diference p<0.001