Revista multidisciplinaria
Investigación Contemporánea 01 - 2025 Vol. 3 - No. 1 ISSN-e: 2960-8015
Original article. Revista Multidisciplinaria Investigación Contemporánea.
Vol. 3 - No. 1, pp. 1 - 16. January-June, 2025. e-ISSN: 2960-8015
Prevalence of periodontal disease,
malocclusion and pulp necrosis in the
Nueva Vida community, Guayaquil,
Ecuador
Prevalencia de enfermedad periodontal, maloclusión y necrosis
pulpar en la comunidad Nueva Vida, Guayaquil, Ecuador
1 Universidad Politécnica Salesiana; kchavezg@ups.edu.ec. Guayaquil, Ecuador.
2 Universidad Politécnica Salesiana; fsanchez@ups.edu.ec. Guayaquil, Ecuador.
3 Universidad Politécnica Salesiana; lsantaella@ups.edu.ec. Guayaquil, Ecuador.
Karol Leonor Chávez Gónzález 1*, Francisco Sánchez Almaraz 2, Luis Eduardo Santaella Palma 3
DOI: https://doi.org/10.58995/redlic.rmic.v3.n1.a79
How to cite:
Chávez Gónzález KL, Almaraz FS, Santaella Palma LE. Prevalence of periodontal disease, malocclusion and pulp
necrosis in the Nueva Vida community, Guayaquil, Ecuador. REVMIC [Internet]. 2024 Oct. 22 [cited 2024 Oct.
22];3(1). Disponible en: https://doi.org/10.58995/redlic.rmic.v3.n1.a79
Article information:
Received: 27-04-2024
Accepted: 06-09-2024
Published: 01-01-2025
Editor's note:
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dictional claims in published messages and
institutional afliations.
Publisher:
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Sources of nancing:
The research was carried out with own resources.
Conicts of interest:
No conicts of interest.
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Revista multidisciplinaria
Investigación Contemporánea 01 - 2025 Vol. 3 - No. 1 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n1.a79
Prevalence of periodontal disease, malocclusion and pulp necrosis in
the Nueva Vida community, Guayaquil, Ecuador 2 - 16
Abstract
Introduction: Periodontal disease, dental uorosis and pulp necrosis are common
clinical conditions in the dental context. Objective: to determine the prevalence of
periodontal disease, malocclusion, dental uorosis and pulp necrosis. Methodology:
quantitative, observational and cross-sectional study, applying judgmental
sampling, which included the 29 patients who met the inclusion criteria in the study
and attended the dental care day developed in the Nueva Vida community, Guayaquil,
Ecuador; by the Salesian Polytechnic University, María Auxiliadora Campus, in
2023. Results: a) prevalence of periodontal disease: (79.31%); b) prevalence of
malocclusion (82.76%); c) prevalence of dental uorosis (44.82%); d) prevalence
of pulp necrosis (6.89%). Conclusions: Periodontal disease and malocclusion were
predominant in the age group under 18 years and in the female sex. Dental uorosis
was predominant in males and under 18 years of age. Pulp necrosis occurred in the
age group under 18 years, with no predominance by sex. No statistically signicant
association was found between periodontal disease, malocclusion, uorosis and
pulp necrosis with age group and sex.
Keywords: dentistry, epidemiology, age, sex, disease.
Resumen
Introducción: La enfermedad periodontal, uorosis dental y necrosis pulpar son
condiciones clínicas frecuentes en el contexto odontológico. Objetivo: determinar la
prevalencia de la enfermedad periodontal, maloclusión, uorosis dental y necrosis
pulpar. Metodología: Estudio cuantitativo, observacional, y transversal aplicando
muestreo por juicio, que incluyó a los 29 pacientes que cumplieron con los criterios
de inclusión en el estudio y acudieron a la jornada de atención odontológica
desarrollada en la comunidad Nueva Vida, Guayaquil, Ecuador; por parte de la
Universidad Politécnica Salesiana, Campus María Auxiliadora, en 2023.Resultados:
a) prevalencia de enfermedad periodontal(79,31%); b) prevalencia de maloclusión
(82,76%); c) prevalencia de uorosis dental (44,82%); d) prevalencia de necrosis
pulpar (6,89%). Conclusiones: Predominó la enfermedad periodontal y maloclusión
en edad inferior a 18 años y en sexo femenino. La uorosis dental predominó en sexo
masculino y edad inferior 18 años. La necrosis pulpar se presentó en edad menor a
18 años, sin predominio por sexo. No se evidenció una asociación estadísticamente
signicativa entre enfermedad periodontal, maloclusión, uorosis y necrosis pulpar
con el grupo etario y sexo.
Palabras clave: odontología, epidemiología, edad, sexo, enfermedad.
Revista multidisciplinaria
Investigación Contemporánea 01 - 2025 Vol. 3 - No. 1 ISSN-e: 2960-8015
DOI: https://doi.org/10.58995/redlic.rmic.v3.n1.a79
Prevalence of periodontal disease, malocclusion and pulp necrosis in
the Nueva Vida community, Guayaquil, Ecuador 3 - 16
1. Introduction
Periodontal disease is a condition of the tissues that make up the periodontium,
which causes loss of attachment and destruction of the alveolar bone. In the
most severe cases, it can result in tooth loss. The diagnosis is made based on the
clinical signs and symptoms of the tissues. In a healthy periodontium, a pale pink
stippled gum can be observed; however, this characteristic can vary according
to different races (1). It is estimated that chronic periodontitis has a global
prevalence ranging from 15 to 30 % (2). In Ecuador, an estimated prevalence of
mild periodontitis has been recorded in 21.7 % of cases, moderate periodontitis
in 34.9% and severe periodontitis in 39.7 % , using Armitage criteria (3).
The American Association of Periodontology classies periodontal
diseases into several categories: I) Gingival diseases, which include plaque-
induced and non-plaque-induced diseases; II) Chronic periodontitis, which
may be localized or generalized; III) Aggressive periodontitis, also classied
as localized or generalized; IV) Periodontitis as a manifestation of a systemic
disease; V) Necrotizing periodontal diseases; VI) Abscesses of the periodontium;
VII) Periodontitis associated with endodontic lesions; and VIII) Developmental
or acquired deformities and conditions.
Dental uorosis is an alteration in the normal development of enamel
caused by excessive exposure to uoride, which interferes with the proper
formation of hydroxyapatite crystals in the enamel. This disorder is classied
as mild, moderate and severe, depending on the degree of involvement and
the extent of visible stains on the enamel. The severity of uorosis is directly
related to the time and duration of exposure, with the main risk factors being the
consumption of drinking water with a high uoride content, the use of uoride
supplements and excessive topical application of uoride products. The most
critical period of overexposure occurs between 1 and 4 years of age, when teeth
are developing, while at 8 years of age, the risk decreases considerably, since
permanent teeth have completed their formation. The most commonly affected
teeth are the permanent incisors, which often show discoloration and, in severe
cases, even structural defects. The safe level of uoride intake is estimated
between 0.05 and 0.07 mg F/kg/day, to avoid complications such as uorosis
(4).
Revista multidisciplinaria
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Prevalence of periodontal disease, malocclusion and pulp necrosis in
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On the other hand, pulp necrosis is a serious pathological process that
involves the degeneration of pulp tissue within the teeth. It is usually caused by
bacterial infections (septic etiology) or physical trauma that compromise the
vascular-nervous system of the dental pulp, preventing the supply of blood and
nerves necessary for its vitality. There are three main types of pulp necrosis:
by coagulation, in which the pulp denatures and hardens; by liquefaction,
where the tissue dissolves forming a viscous material; and pulp gangrene,
characterized by the putrefaction of the pulp tissue due to bacterial invasion
(5, 6).(5)(6) Pulp necrosis can result in the complete loss of tooth vitality, requiring
interventions such as root canal treatments or, in advanced cases, the extraction
of the affected tooth.
Furthermore, malocclusion is one of the most common alterations in oral
health and constitutes a major public health problem due to its prevalence and
the functional and aesthetic implications it entails. Malocclusion refers to an
incorrect alignment of the teeth, which affects the way they relate to each other
when the mouth is at rest or during chewing. This alteration can be inuenced
by multiple factors, including the shape and size of the teeth, the craniofacial
growth pattern, the conguration of the dental arches and the eruption
schedule of permanent teeth. The consequences of an untreated malocclusion
can include chewing difculties, speech problems, jaw pain and an increased
risk of periodontal diseases (7).
Considering that dental uorosis, pulp necrosis and malocclusion are
common clinical conditions in dental practice and can signicantly affect
patients’ quality of life, it is crucial to conduct this research in the Nueva Vida
community. This community faces limitations in accessing on-site dental care,
which underlines the importance of exploring the prevalence and potential
solutions to these dental pathologies in a context where adequate prevention
and treatment are less accessible.
For the above reasons, the objective of this research is to determine the
prevalence of periodontal disease, malocclusion, dental uorosis and pulp
necrosis, in the Nueva Vida community, Guayaquil, Ecuador, in order to direct
oral health promotion and secondary prevention campaigns, based on the most
frequently detected oral pathologies in the community studied.
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Prevalence of periodontal disease, malocclusion and pulp necrosis in
the Nueva Vida community, Guayaquil, Ecuador 5 - 16
2. Materials and Methods
A quantitative, observational, descriptive and cross-sectional study was carried
out, applying judgmental sampling, which included the 29 patients who met the
inclusion criteria in the study and who attended the dental care day developed
in the Nueva Vida community, Guayaquil, Ecuador; by the Salesian Polytechnic
University, María Auxiliadora Campus, in 2023.
Inclusion criteria were voluntary participation in the study, age over
6 years, not having received dental treatment in the previous 6 months, and
residing in the Nueva Vida community. Exclusion criteria: Not residing in the
Nueva Vida community, patients with dental treatment in the last six months,
or with a history of allergic reactions to dental material. Variables considered
in this research: age, sex, periodontal disease, uorosis, malocclusion, and pulp
necrosis.
The instrument used for data collection was the Single Dental Clinical
History form (HCU-033) and the clinical data registration form. The procedure
used for data collection included the selection of subjects who met the inclusion
criteria described previously. For the diagnosis of periodontal disease, uorosis,
malocclusion and pulp necrosis, the following parameters were considered,
determined from the clinical examination performed on the subjects included
in the study, considering the following indices and scales:
Periodontal disease was classied according to its severity as mild,
moderate, and severe or advanced, based on the loss of attachment. In the case
of mild disease, an attachment loss of between 1 and 2 millimeters was observed.
For moderate disease, the attachment loss was 3 to 4 millimeters. Finally, in
severe or advanced cases, an attachment loss greater than 5 millimeters was
presented, which in many cases can lead to tooth loss (8). This classication
allows to evaluate the degree of involvement of the periodontium and to plan
an appropriate treatment according to the severity of the disease.
Regarding malocclusion, Angle's classication was used, which
distinguishes three main classes. Class I is characterized by the mesio -buccal
cusp of the upper rst molar occluding in the mesio -buccal groove of the lower
rst molar, which is considered a normal occlusion. Class II, on the other hand,
is dened when the mesio -buccal cusp of the upper rst molar occludes in
front of the mesio -buccal groove of the lower rst molar, which generates a
misaligned occlusion. Finally, in Class III, the mesio -buccal cusp of the upper
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n1.a79
Prevalence of periodontal disease, malocclusion and pulp necrosis in
the Nueva Vida community, Guayaquil, Ecuador 6 - 16
rst molar occludes behind the mesio -buccal groove of the lower rst molar,
producing a more marked misalignment (7). This classication is essential for
orthodontic diagnosis and treatment.
Dental uorosis was assessed using a classication ranging from normal
to severe. In normal, healthy teeth, the enamel appears smooth, shiny and
without opacities. In very mild cases, small white opaque areas are observed
affecting less than 25% of the labial surface of the tooth. When uorosis is mild,
the opacities are more evident, but cover less than 50% of the tooth surface.
In moderate cases, these opacities cover 50% or more of the tooth surface,
while in severe uorosis, the enamel is deeply affected, with alterations in its
morphology, an eroded appearance and the presence of brown spots (9). This
assessment helps to determine the degree of damage to the enamel due to
excessive exposure to uoride.
Finally, pulp necrosis was diagnosed in teeth that presented certain
characteristic signs. These included changes in tooth color, with a darker shade
compared to healthy teeth. In some cases, complete destruction of the dental
crown was evident, leaving only the tooth roots exposed. In addition, pulp
necrosis was conrmed by the lack of response to thermal tests, which indicate
the loss of vitality of the pulp tissue (10). These criteria are essential for the
diagnosis and treatment of teeth with necrosis.
Data analysis was performed by entering the data into a Microsoft Excel
spreadsheet (version 2021), structured based on the variables described above,
where the clinical data corresponding to the evaluated subjects who met the
inclusion criteria were tabulated.
The data analysis was processed by the statistical software Statistical
Package for the Social Sciences (SPSS version 26), using: a) univariate analysis
(with frequency histograms for qualitative variables and calculation of central
tendency measures in quantitative variables) ; b) bivariate analysis (using
contingency tables and Pearson's Chi Square test, considering the value of
p<0.05 as statistically signicant).
Regarding bioethical aspects, the subjects included in the study and/
or their legal guardians voluntarily agreed to participate. The authors of this
research declare that they have no conicts of interest.
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Prevalence of periodontal disease, malocclusion and pulp necrosis in
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3. Results
The 29 patients who met the inclusion criteria were between 7 and 79 years
old, with an estimated mean of 15.72 years and SD ± 12.76 years. There was a
predominance of adolescents in the subjects evaluated (Figure 1).
Figure 1. Distribution of subjects assessed by age groups.
On the other hand, there was a predominance of the female sex (62.06%)
over the male sex (37.94%) in the population studied (gure 2).
Figure 2. Distribution of the subjects evaluated, according to sex.
8
18
21
0
2
4
6
8
10
12
14
16
18
20
ESCOLARES/NIÑOS
ADOL ES CEN TES
JOV ENES
A DU LTOS
ADULTOS MAYORES
Age
18
11
0
2
4
6
8
10
12
14
16
18
20
FEMENINO M ASC U LI NO
Sex
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Prevalence of periodontal disease, malocclusion and pulp necrosis in
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Regarding the prevalence of periodontal disease, it was found that 79.31
% of the subjects studied had mild periodontal disease, 82.61% had severe
periodontal disease, and 4.35% had moderate periodontal disease (Figure 3).
Figure 3. Distribution of the frequency of periodontal disease, according to the level of severity.
When studying the prevalence of malocclusion, it was found that 82.76%
had a relationship between the rst upper molar and the rst lower molar
compatible with Angle class I, 13.79% had a malocclusion corresponding to
Angle class II and 3.45% had Angle class III (Figure 4).
Figure 4. Distribution of malocclusion frequency, according to Angle classication.
19
1
3
0
2
4
6
8
10
12
14
16
18
20
LE VE M O DE R A DA S EV E R A
Periodontal
24
4
1
0
5
10
15
20
25
30
A N GL E I A N GL E I I ANGL E III
Malocclusion
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Prevalence of periodontal disease, malocclusion and pulp necrosis in
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Fluorosis had a prevalence of 44.82 % . It should be noted that all subjects
in whom dental uorosis was detected had clinical characteristics compatible
with the mild stage (Figure 5).
Figure 5. Distribution of the frequency of dental uorosis, according to the level of severity.
Pulp necrosis occurred in only 6.89% of the subjects studied (see Figure 6).
It is pertinent to mention that both cases were recorded in adolescents between
16 and 17 years of age.
Figure 6. Distribution of the frequency of pulp necrosis in the subjects evaluated.
13
0 0
0
2
4
6
8
10
12
14
LE VE M O DE R A DA S EV E R A
Dental
2
27
0
5
10
15
20
25
30
CON NECROSIS PULPAR SIN NECROSIS PULPAR
Pulp
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Prevalence of periodontal disease, malocclusion and pulp necrosis in
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When performing the bivariate analysis between periodontal disease,
malocclusion, uorosis and pulp necrosis with the age group and sex of the
study participants, a predominance of the prevalence of periodontal disease
and malocclusion was evident in those under or equal to 18 years of age and in
the female sex (Table 1). On the other hand, the prevalence of dental uorosis
predominated in the male sex and in those under or equal to 18 years of age
and in the male sex. Regarding the prevalence of pulp necrosis, it occurred
exclusively in those under or equal to 18 years of age, with no predominance by
sex being evident. It should be noted that no statistically signicant association
was obtained between: a) periodontal disease and age ( p= 0.160); b) periodontal
disease and sex ( p= 0.794); c) malocclusion and age ( p= 0.967); d) malocclusion
and sex ( p= 0.917); e) uorosis and age (0.525); f) uorosis and sex ( p= 0.111); g)
pulp necrosis and age ( p= 0.454); h) pulp necrosis and sex ( p= 0.715).
Table 1. Bivariate analysis between age, sex, periodontal disease, malocclusion, uo-
rosis and pulp necrosis.
Variable
Age Sex
<18 years
(Children and
Teenagers)
>18 years Youth,
Adults and
Seniors
Female Male
Periodontal
Disease
YEAH 17 (58.6%) 6 (20,7%) 14 (48,3%) 9 (31%)
NO 6 (20.7%) 0 (0%) 4 (13,8%) 2 (6,9%)
p0,160 0,794
Maloclusión
ANGLE I 19 (65,5%) 5 (17,2%) 15 (51,7%) 9 (31%)
ANGLE II Y III 4 (13,8%) 1 (3,4%) 3 (10,3%) 2 (6,9%)
p0,967 0,917
Fluorosis
YEAH 11 (37,9%) 2 (6,9%) 6 (20,7%) 7 (24,1%)
NO 12 (41,4%) 4 (13,8%) 12 (41,4%) 4 (13,8%)
p0,525 0,111
Pulp necrosis YEAH 2 (6,9%) 0 (0%) 1 (3,4%) 1 (3,4%)
NO 21 (72,4%) 6 (20,7%) 17 (58,6%) 10 (34,5%)
p0,454 0,715
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Prevalence of periodontal disease, malocclusion and pulp necrosis in
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4. Discussion
A prevalence of periodontal disease was found in 79.31 % of the subjects studied.
This nding contrasts with a study conducted in Mexico in 2019 by Viramontes
et al. (11), which included 54 university students, with an average age of 18.87
years; showing an estimated prevalence of periodontal disease of 27.8%. On the
other hand, a study conducted in Mexico in 2020 by Lira et al. (12), which included
3968 patients, with an average age of 15 years, who attended a university dental
clinic, recorded an estimated prevalence of periodontal disease of 2%.
When studying the prevalence of malocclusion, it was found that 82.76
% had a relationship between the rst upper molar and the rst lower molar
compatible with class I of the Angle classication. These results contrast with
a research carried out in Cuba during 2021, by Villafañe and De Los Reyes (13),
which included 61 children between the ages of 6 and 11 years, recorded a
prevalence of malocclusion of 44.26%, with class II predominating in the Angle
classication.
Dental uorosis recorded a prevalence of 44.82 % . It should be noted
that all subjects, in whom dental uorosis was detected, presented clinical
characteristics compatible with the mild stage. These ndings contrast with
a research developed in Mexico, by Aguirre et al. (14), ), which included 209
high school students, aged between 12 and 15 years, obtaining an estimated
prevalence of dental uorosis of 79.9 % . On the other hand, a review of the
literature developed in Ecuador, in 2023, which included 15 studies framed
in the detection of dental uorosis; recorded an average prevalence of dental
uorosis of 12.67 % .
Pulp necrosis occurred in only 6.89% of the subjects studied. It is pertinent
to mention that the two cases were recorded in adolescents between the ages of
16 and 17 years old. A research carried out in Ecuador, by Hurtado et al., which
included 174,611 patients treated in health centers between 2017 and 2020, in
Zone 7 of the Ministry of Public Health; recorded a prevalence of pulp necrosis
of 6.63% (15).
A predominance of the prevalence of periodontal disease and malocclusion
was evidenced in the age group less than or equal to 18 years and in the female
sex. On the other hand, the prevalence of dental uorosis predominated in the
sex less than or equal to 18 years and in the male sex. Regarding the prevalence
of pulp necrosis, it occurred exclusively in the age group less than or equal to
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DOI: https://doi.org/10.58995/redlic.rmic.v3.n1.a79
Prevalence of periodontal disease, malocclusion and pulp necrosis in
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18 years, without evidence of a predominance by sex. There was no statistically
signicant association between periodontal disease, malocclusion, uorosis and
pulp necrosis with the age group and sex. These results contrast with a research
published in Peru during 2019, developed by Manzur (16), which included the
review of 49,619 clinical records corresponding to patients treated in a health
center, between 2010 and 2017, with an estimated mean age of 21.9 years; which
reported a prevalence of pulp necrosis in children estimated at 24.4%. On the
other hand, in adolescents, the prevalence of pulp necrosis was 10.2% and
gingivitis in 8.1%. In young people, a prevalence of pulp necrosis was recorded
in 12.4% and gingivitis in 10.8%. In adults, a prevalence of pulp necrosis was
evidenced in 23.1% and gingivitis in 10.8%. In older adults, pulp necrosis was
recorded in 45.5% of cases. In relation to the male gender, pulp necrosis was
recorded in 24.9% and gingivitis in 5.3%. In the female gender, pulp necrosis
was detected in 16.4% and gingivitis in 8.2%. Reporting a statistically signicant
association when correlating oral diseases and age group (p = 0.000 <0.05), as
well as the presence of oral diseases and gender (p = 0.000 <0.05).
A study conducted in Ecuador by Hurtado et al., which included 174,611
patients between the ages of 20 and 40, treated in health centers during 2017
to 2020, in Zone 7 of the Ministry of Public Health; recorded a prevalence of
pulp necrosis in 11,597 cases. In these cases, a predominance was recorded in
the female sex and age between 20 and 31 years (15).
5. Conclusions
Predominance of mild periodontal disease prevalence was evident .
Malocclusion compatible with Class I in the Angle classication was the
most frequent stage in the subjects evaluated.
All cases of dental uorosis detected correspond to the mild stage.
Pulp necrosis occurred exclusively in the adolescent age range.
A predominance of the prevalence of periodontal disease and malocclusion
was found in the age group under or equal to 18 years and in the female sex.
On the other hand, the prevalence of dental uorosis predominated in the sex
under or equal to 18 years and in the male sex. Regarding the prevalence of
pulp necrosis, it occurred exclusively in the age group under or equal to 18
years, with no predominance by sex being found. No statistically signicant
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Prevalence of periodontal disease, malocclusion and pulp necrosis in
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association was found between periodontal disease, malocclusion, uorosis
and pulp necrosis with the age group and sex.
6. Authors' Contribution
KLCG: Data collection, analysis of results and nal review of the article.
FSA: Data collection, discussion and nal revision of the article.
LESP: Analysis of results, discussion, nal revision of the article.
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