Risk indicators of aggressive periodontitis in a Jordanian ...

Knowledge of the risk indicators of aggressive periodontitis (AgP) will help clinicians to better diagnose the disease, put a treatment plan ... Skiptomaincontent Advertisement SearchallBMCarticles Search DownloadPDF Researcharticle OpenAccess Published:16July2019 RiskindicatorsofaggressiveperiodontitisinaJordanianpopulation KhansaT.Ababneh1,2,ManalJ.Maslamani  ORCID:orcid.org/0000-0002-5063-80243,MunaS.Abbadi4,AnasH.Taha5,JumanaA.Karasneh6,AmaniG.Sa’di7&YousefS.Khader8  BMCOralHealth volume 19,Article number: 155(2019) Citethisarticle 1730Accesses 1Citations 1Altmetric Metricsdetails AbstractBackgroundKnowledgeoftheriskindicatorsofaggressiveperiodontitis(AgP)willhelpclinicianstobetterdiagnosethedisease,putatreatmentplanthatinvolvesmodificationofmodifiableriskindicators,understandnon-modifiableriskindicators,andmaypotentiallyserveasanaidindevelopingpreventiveprograms.Theobjectiveofthepresentstudywastoassessriskindicatorsofaggressiveperiodontitis(AgP)inJordanincludingsocio-demographicfactors,oralhygienehabits,smoking,familyhistoryandparents’consanguinity.MethodsAtotalof162patients(81AgPand81controls),attendingthePeriodontologyclinicatJordanUniversityofScienceandTechnology,DentalTeachingCentre,wereinterviewedandexamined.AllAgPsubjectshadfullperiodontalandradiographicexamination.Thedatarecordedincludedsocio-demographicandeconomicvariables,oralhygieneandsmokinghabits,familyhistoryandparents’consanguinity.ResultsMostAgPpatientswereyoungfemales,had≤12 yearsofeducation,livedinurbanareasandbrushedtheirteeth≥oncedaily.RiskindicatorsofAgPincluded:age > 35 years,femalegenderandpositivefamilyhistory.ConclusionsRiskindicatorsassociatedwithAgPinthisstudypopulationwere:age > 35 years,femalegenderandpositivefamilyhistoryofperiodontaldisease. PeerReviewreports BackgroundPeriodontitisisamultifactorialdiseasecharacterizedbyattachmentandbonelossaroundteeth.Theincidenceandprogressionofthediseaseareinfluencedbytheinteractionofgenetic,microbialandenvironmentalfactorssuchasdentalplaque(biofilm),age,gender,ethnicity,systemicdiseases,smoking,psychological,geneticpolymorphismsandsocialfactors[1,2,3].TheAmericanAcademyofPeriodontologyhasclassifiedperiodontitisintochronicperiodontitis(CP),aggressiveperiodontitis(AgP),andperiodontitisassociatedwithsystemicdiseases[4].CasedefinitionofAgPhasbeenmodifiedseveraltimes,fromtheearlyworkofOrbanandWeinmann(1942)[5],whointroducedtheterm“periodontosis”,throughthemoreelaboratedefinitionpresentedbyBaerin(1971)[6],tothelatestcasedefinitionproposedbytheAAP,in1999.[4].The1999AAPreportstatesthatAgPaffectsotherwisehealthyindividualsandischaracterizedbyrapidattachmentandbonedestructionatanearlyage,familialaggregation,phagocyteabnormalities,thepresenceofahyper-responsivemacrophagephenotype,elevatedlevelsofprostaglandinE2andinterleukin-1ß,andalterationinthehostimmuneresponse[4,7].AsystematicreviewofliteraturebySusinetal.,(2014)ontheepidemiologyanddemographicsofAgP[8],hasdemonstratedthattheprevalenceofAgPinEuroperangesbetween0.1–0.2%;inNorthAmerica0.5–1.7%,dependingonthecasedefinitionandsampletype(age,ethnicity);inSouthAmericafrom0.3–3.7%;InAsiavariedform1.8–5.9%andinAfricafrom0.7–8.6%.Thisreviewhashighlightedtwomainfacts;thefirstisthatAgPisasignificanthealthproblemincertainpopulationsandthesecondisthelackofinformationontheepidemiologyofAgPinmanypartsoftheworld.EpidemiologicalstudiesofAgPinhigh-riskpopulationsareimportantandcouldprovidevitaldataonthedeterminantsofthisdisease,andthisinformationisneededfortheestablishmentofeffectivehealth-promotionmeasures[8].Theriskindicatorsexaminedinthisstudyincludeddemographicandsocioeconomicfactors,oralhygienehabits,smoking,familyhistoryandparents’consanguinity.Thereasonforselectingthesespecificriskindicatorsisthestrongassociationbetweenthemandperiodontitis,asdemonstratedbyotherresearchers[9].PatientsandmethodsStudydesignThepresentstudyisacase-controlstudy,whichinvolved162patientsattendingJordanUniversityofScienceandTechnology(JUST)DentalTeachingCenter(DTC)inIrbid.Thesubjectsincludedwere ≥ 14 yearsofageanddeniedhavinganymedicalproblems.Thediseasegroupconsistedof81AgPpatientsandthecontrolgroupconsistedof81periodontitis-freesubjects.ExclusioncriteriaPatientswhoreportedanymedicalorphysiologicconditionassociatedwithperiodontitisandlistedinthelatestAAPclassification[4],includingdiabetesmellitus,blooddisorders,immunosuppression,pregnancy,patientsonlongtermmedicationssuchascontraceptivesandsteroidswereexcludedfromthestudy.Subjectswhohadreceivedperiodontaltreatmentinthelast3 monthspriortoexamination,andpatientswithcurrentorpreviousorthodontictreatmentwerealsoexcluded.Interview,clinicalandradiographicexaminationThisstudywasconductedinfullaccordancewithethicalprinciplesoftheWorldMedicalAssociationDeclarationofHelsinki[10].ApprovalforthisstudywasobtainedfromtheEthicalCommitteeintheDeanshipofScientificResearch,IRB,JUST,andinformedconsentformsforinterviewandexaminationweresignedbyallsubjectsandtheparentsofsubjectsundertheageof18 years.Foreachsubject,aquestionnairewascompletedandincluded:age,gender,occupation,educationlevel,presenceofperiodontalproblemsamongotherfamilymembers,parents’consanguinity,smokinghabits,andoralhygienehabits.FullmouthperiodontalexaminationwascarriedoutwhichincludedmeasurementofClinicalAttachmentLevel(CAL),thegingivalindex(GI)ofLöeandSilness[11]andtheplaqueindex(PI)ofSilnessandLöe[12].FormeasurementofCAL,eachtoothwasexaminedby“walking”theperiodontalprobearoundthewholecircumferenceofthetooth.CALwasmeasuredatsixsitespertooth(mesio-,mid-,anddisto-buccal;mesio-,mid-,anddisto-lingual/palatal).Thirdmolarsandremainingrootswereexcluded.Inter-examinerreliabilityregardingprobingdepthandCALwascalculatedon16quadrants,usingalphastatistics.DiagnosisofAgPwasbasedonCALvaluesandconfirmedradiographicallyusingintra-oralperiapicalandbitewingradiographs.Forallparticipantsbitewingradiographsweretakenforposteriorteethandperiapicalradiographsweretakenforanteriorteethtodetectthepresenceandpatternofalveolarbonelossandconfirm(orexclude)thepresenceofperiodontitis.AgPwasdiagnosedwhenthesubjecthadCAL ≥ 3 mmaroundatleasttwoteeth,oneofwhichwasafirstmolar,orwhenattachmentlosswasobservedaroundfirstmolarsand/orincisorsthatexhibitedboneloss,especiallywerethecharacteristicarc-shapeddefect(s)was/weredetectableonradiographs,thecasewasdiagnosedasAgP.Inconsistencebetweentheamountofplaquedepositsandtheamountofperiodontaldestruction(wheneverpresent),andpositivefamilyhistoryfurtherconfirmedthediagnosisofAgP.CaseswheretherewasanyuncertaintybetweenthediagnosisofAgPorCPwerenotincludedinthisstudy.ControlsThecontrolsampleconsistedof81periodontitis-freeJordaniansubjects,noneofwhichdemonstratedattachmentorbonelossatanysite.Thecontrolsubjectsreceivedfullperiodontalexaminationtoconfirmthattheywereperiodontitis-free.StatisticalanalysisDatawereenteredintoapersonalcomputerandanalyzedusingtheStatisticalPackageforSocialSciences(SPSS)softwareversion11.0(SPSS®:Inc.,Chicago,IL,USA).Frequencydistribution,meansandstandarddeviationswerecalculated.Independentt-andchisquaretestswereusedforcomparisonamonggroupsasappropriate.Furthermore,multivariatelogisticregressionmodelanalyses,analyzingtheassociationbetweenexplanatory(independent)anddependantvariables,wereperformedtotesttheassociationoftheoutcomeswiththeindependentvariablesthatwereincludedinthemodelsbyusingbackwardstepwiseWaldmethod(BSTEP).InthisBSTEPmethod,allthepossiblevariableswereenteredintothemodel.Theindependentvariablesspecifiedinthevariableslistwerethentestedforpossibleremovalfromthemodelonebyoneateachstep,basedonthelevelofsignificanceintheWaldstatistics.ThevariablewiththesmallestsignificancecomposedtoPIN(probabilityforentry)(0.05)wasleftinthemodel.IfthesignificancelevelwasgreaterthanPOUT(probabilityforremoval)(0.1)thevariablewasremoved.Thealgorithmstoppedwhennomorevariablescouldbeenteredorremoved.Adjustedoddsratios(OR)weregeneratedcorrespondingto95%confidenceintervals(CI)forallsignificantvariables.Thelevelofsignificancewassetat(P ≤ 0.05).ResultsSocio-demographiccharacteristicsThestudypopulationwasdividedintotwoagegroups(Table 1).TheageoftheAgPgrouprangedbetween16-46 yearswithameanof29.7 years;whereastheageofthehealthygrouprangedbetween14-37 yearswithameanof22.3 years.AlthoughthemajorityofAgPpatientsandcontrolswere ≤ 35 yearsofage,therewasastatisticallysignificantdifferencebetweenthetwogroups(P =  12 years),withastatisticallysignificantdifference.ThemajorityofAgPpatientsandcontrolsreportedlivinginurbanareas,buttherewasnosignificantdifferencebetweentheperiodontitisandcontrolgroups.Table1Socio-demographicCharacteristicsoftheStudyPopulationFullsizetableOralhygienehabitsandfrequencyofdentalvisitsTable 2showsthatthemajorityofsubjectsinthediseaseandcontrolgroupsreportedbrushingtheirteeth≥1time/day,butthedifferencebetweenthemwasnotsignificant.ThehighestpercentageofAgPsubjectsreportedusingavertical(scrub)method,whereasthehighestpercentageofcontrolsreportedusingasimplecircularmethod.Themajorityofallsubjectsreportedattendingdentalclinicsforemergencytreatmentonly.About22%ofAgPcasesand8.5%ofcontrolsreportedattendingdentalclinicsregularly.Table2OralHygieneHabitsandPatternofDentalVisitsFullsizetableCigarettesmoking,familyhistoryandparentconsanguinityTable 3showsthatabout20%ofthewholestudypopulationwerecigarettesmokers.ThisTabledemonstratesthat16%ofAgPpatientsand17.3%ofcontrolsreportedsmoking.AllAgPsmokerpatientswerelightsmokers( 5 years.Inthecontrolgroup,71.4%reportedsmoking≥10cigarettesandabout43%reportedsmokingfor> 5 years.TherewasasignificantdifferencebetweenAgPpatientsandcontrolsregardingthenumberofsmokedcigarettes/day(P =  35 years,femalegenderandpositivefamilyhistory.Subjectsage > 35 yearswasthestrongestindicatorassociatedwithAgP(OR = 10.12).Whenpatientswereolderthan35 yearstheywereabouttentimesmorelikelytohaveAgPcomparedwiththeyoungergroup(≤35 years).Whenthepatientswerefemale,theywereaboutfourtimesmorelikelytohaveAgPincomparisonwithmales.Inaddition,patientswhoreportedpositivefamilyhistoryofperiodontitisweretwicemorelikelytohaveAgPcomparedwiththosewhoreportednegativehistory.Table5MultiplelogisticregressionmodelforAgPandCP(N = 262)FullsizetableDiscussionStudyingriskindicatorsofperiodontitisprovidesdentalclinicianswithinsightintothecausativeandpossiblecontributingfactorsofthisuniqueandcomplexdiseaseintheirsociety.Thiswouldimprovediagnosis,treatmentplanning,treatment,preventionandreferralofAgPcases.Socio-demographicfactorsAgeThemajorityofAgPpatientswereyoung,whichisinagreementwiththetendencyofAgPtostartearlyinlife[13].Albandaretal.[14]reportedthattheprevalenceofEOPinUgandanschoolattendeesaged12-25 yearswashigh(28.8%).The1999AAPclassificationhasminimizedthevalueofageinthediagnosisofAgP,althoughstillstatingthatAgPaffectsyoungindividuals[7].Interestingly,themultivariateanalysisshowedthattheoddsofhavingAgPinsubjectsolderthan35 yrs.was10timeshigherthaninthoseunder35 yrs.Thisresultwasprobablyobtainedduetotwofactors:first;thecontrolsubjectswereyoungerthanAgPsubjects,simplymeaningthattheywereyounganddidn’thaveperiodontitis.Second;thediagnosisofperiodontitiswasbasedonCALvalues,sothatthis“higheroddsofhavingAgPwithincreasingage”probablyreflectsthecumulativeeffectofAgP(manifestedasgreaterattachmentloss)thathadaffectedthesepatientsatayoungerage,andprogressedwithincreasingage.Thisfindingissupportedbytheresultsofotherstudies[8,15].SuchasthestudyofAlbandaretal.[8]whoestimatedtheprevalenceofaggressiveperiodontitisinUSschoolchildrentobe0.4%among13-to15-yearoldchildrenand0.8%amongthe16-to19-year-oldgroup.Anotherstudyinvestigated13-year-oldBrazilianchildrenatbaselineand3 yearslaterandfoundahigherpercentageofAgPintheolderagegroup[7,16].GenderMorethanonehalf(57%)oftheparticipantsinthisstudywerefemales.FemalesrepresentedmostoftheAgPgroup,asopposedtocontrols,wherethenumberofmaleswashigher.ThemultivariatelogisticregressionanalysisrevealedthatfemaleswereaboutfourtimesmorelikelytohaveAgP,inagreementwithsomestudiesonCaucasians[8,17].ArecentcomprehensivereviewoftheliteratureontheprevalenceanddemographicsofAgPbySusinetal.[15]showedthatthereisacomplexrelationshipbetweentheprevalenceofAgP,gender,andcertaindemographicvariables,suchasrace/ethnicity.Thisreviewshowedthatinmostpopulationstheprevalenceofaggressiveperiodontitisissimilarinmaleandfemalesubjects.Asurveyinvolving17-26 yrs.oldAmericanrecruits[18],foundthattheprevalenceofjuvenileperiodontitiswassimilarinmalesandfemales.However,theyobservedasignificantlyhigherprevalenceofjuvenileperiodontitisinmalesthaninfemaleswhenonlyblackrecruitswerestudied,indicatingthatgenderdistributionofAgPdiffersbetweenethnicgroups[18].Thisstudyreportedthefollowingfemale:maleratiosofdiseaseprevalence:0.52:1inBlackpeople;4.3:1inCaucasians;and3:1inotherraces.EducationandresidencyThemajorityofAgPpatientshadreceived≤12 yearsofeducation(equaltoorlessthanhighschool).Previousstudieshavereportedthateducationandplaceofresidenceareimportantfactorsinperiodontalhealthbuteducationhasagreaterinfluenceonthelevelofperiodontitis[19,20].MostAgPpatientsinourstudyreportedlivinginurbanareas,whichmayindicatethatAgPpatientslivinginthecityseekperiodontaltreatmentmorefrequentlythanruralareadwellers.Ruralareasoftenhavepoorersocioeconomicconditionsandmedicalfacilitiesthanurbanareas.Oralhygienehabits,dentalvisitsandperiodontalparametersDentalplaqueistheprincipaletiologicfactorofperiodontitisasdemonstratedbytheearlystudiesofLöeandco-workers[21].Inthepresentstudy,mostAgPpatientsreportedbrushingtheirteethratherregularly(≥1time/day).Butinspiteofthat,mostofthemhaddentalplaqueandgingivalinflammation.Thismayeitherindicatethatthetoothbrushingmethodsusedbypatientswereincorrectorthattheirreportswereinaccurate.Controlsreportedadequatebrushingfrequency,propertoothbrushingmethodsanddemonstratedbetterperiodontalconditionsthanAgPpatients.Thisisprobablybecausemostofthecontrolsubjectswereyoungeducatedindividualswhotookcareoftheiroralhealth.Axelssonetal.[22]reportedthatintensiveoralhygieneprogramswereeffectiveinreducingtheincidenceofdentalcariesandthelevelofgingivalinflammationinchildrenandadults.Asforthefrequencyofdentalvisits,AgPpatientsvisitedthedentistmorefrequentlythancontrols,possiblyduetotheirneedforcontinuousperiodontaltreatmentand/orreplacementofmissingteeth.Withregardtothepresenceoflocaletiologicfactors,althoughtheoralhygienehabitsreportedbytheAgPandcontrolgroupswerecomparable,theAgPpatientsdemonstratedhigherplaquescoresandattachmentloss.AgPhasbeenassociatedintheliteraturewithminimalamountsofplaque[13],whichisincontrastwithfindingsinourAgPpopulation,whodemonstratedmoreplaquethancontrols.Thisisprobablyrelatedtodifferencesbetweenpopulationsinoralhygienestandardanddentalawareness.TheattachmentlossobservedintheAgPgroupprobablyreflectsperiodontalresponsetodentalplaqueandthehighsusceptibilityofAgPpatientstoperiodontalbreakdown.Classically,AgPhasbeenassociatedwithsmallamountsoflocalfactors[7].PeriodontaldestructioninAgPisinitiatedbytheinteractionbetweenpathogenicmicroorganismsandthehostimmunesystem[23,24],withapronouncedroleofthehostimmunereactions(reviewedbyAlbandar,2014)[7].SmokingEvidencesuggestsaverystrongassociationbetweensmokingandgingivaltissuestatus,periodontaltissuelossandseverityofperiodontitis[3,25].Inthepresentstudy,thepercentageofsmokerswas16.7%ofthewholestudypopulation.ThemajorityofsubjectsintheAgPgroupdeniedsmoking.ThisindicatesthatAgPpatientswerenotheavilyexposedtosmoking;nevertheless,theyhadgreaterperiodontaldestruction,whichsupportsthehighsusceptibilityofAgPpatientstoperiodontalbreakdown.ThereasonwhythepercentageofAgPsmokerpatientswasnothighmaybethatsomeAgPpatientscouldhavebecomeawareoftherisksofsmokingduringtheirvisitstodentalprofessionals.Alternatively,thismaybeduetothefactthatthemajorityofAgPpatientswereyoungfemaleswhousuallydenysmokingintheJordaniansociety,asitisconsideredinappropriateforfemalestosmoke.Althoughsmokingisawell-knownanduniversallyacceptedriskfactorfortheinitiation,progressionandseverityofperiodontitis[26],theresultsofthemultivariateanalysisinthisstudydidnotrevealanyassociationbetweensmokingcigarettes,cigarettenumbersordurationofsmokingandperiodontalstatus.Thisdisagreementmaybeduetovariationsamongstudiedpopulations,samplenumberand,mostly,accuracyandsubjectivityofself-reportingbypatients.Familyhistoryandparents’consanguinityItiswellrecognizedthatAgPaggregatesinfamilies[7,15,27].Acurrentlywidelyheldviewisthatthedestructionobservedinperiodontaldiseaseistheresultofanimproperlyregulatedimmuneresponsetobacterialinfectionratherthanthedirectlydestructiveeffectofthebacterialpathogensthemselves[28].Specificgenotypes,suchaspolymorphismsinIL-1[29,30]geneshavebeenlinkedtoincreasedriskofperiodontaldiseases[31].Inthepresentstudy,morethanhalfofAgPpatientsreportedperiodontalproblemsamongotherfamilymembers,andbythat,significantlydifferedfromcontrols,inagreementwithotherstudies[32].Familialaggregationofperiodontitismayresultfromsharedgenes,sharedenvironmentalexposuresandsimilarsocioeconomicinfluences.Marriagebetweenrelatives,particularlycousins,asasocialhabitintheJordaniansocietywasnotfoundtobeariskindicatorofAgPinthecurrentstudy.Thisisinagreementwithpreviousresults[33,34],butadditionalstudiesarerecommendedtoinvestigatethisfactor.Marriagebetweenrelativescanbelookedatas“inbreeding”,theimpactofwhichiswelldocumentedonMendeliandisorders.However,verylittleisknownontheeffectsofinbreedingonlateonsetandcomplex,multifactorialdiseasessuchasperiodontitis.AstudyconductedonanIsraeli-Arabcommunityreportedthatinspiteofthehighrateofconsanguinity,nosignificantdifferencewasfoundintheprevalenceofcomplexdiseaseslikediabetes,myocardialinfarctionandasthmabetweentheoffspringofconsanguineousversusnon-consanguineousparents[34].ConclusionsThefollowingsriskindicatorswereassociatedsignificantlywithAgPincomparisonwithcontrols:age > 35 years(indicatingthecumulativeeffectofAgP),femalegenderandpositivefamilyhistoryofperiodontalproblems.Withrespecttoeducation,AgPpatientshavestudiedforasignificantlylowernumberofyearsthatcontrolsubjects,whichemphasizestheroleofeducationinpreventionofperiodontaldiseases.AgPpatientshadsignificantlygreaterPI,GI,andperiodontaldestructionthancontrols.TheOralhygieneofthestudypopulationwaspoor,whichpointstoagreatneedforconstructionofnationwideeducationalandpreventiveprograms. 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GoogleScholar  JaberL,ShohatT,RotterJI,ShohatM.ConsanguinityandcommonadultdiseasesinIsraeliArabcommunities.AmJMedGenet.1997;27(4):346–8.Article  GoogleScholar  DownloadreferencesFundingThisprojectwasnotfunded.AuthorinformationAffiliationsDepartmentofPreventiveDentalScience,CollegeofDentistry,KingSaudbinAbdulazizUniversityforHealthSciences,Riyadh,KingdomofSaudiArabiaKhansaT.AbabnehPreviousDepartmentofPreventiveDentistry,FacultyofDentistry,JordanUniversityofScienceandTechnology,Irbid,JordanKhansaT.AbabnehRestorativeDepartment,KuwaitUniversity,KuwaitCity,KuwaitManalJ.MaslamaniPrivatepractice,Amman,JordanMunaS.AbbadiPrivatepractice,AbuDhabi,UnitedArabEmiratesAnasH.TahaOralMedicine,andHumanMolecularGenetics,DepartmentofOralsurgery,OralMedicine,OralPathologyandRadiology,FacultyofDentistry,andFacultyofScienceandArt,BiotechnologyandGeneticEngineeringDepartment,JordanUniversityofScienceandTechnology,Irbid,JordanJumanaA.KarasnehJordanianFoodandDrugadministration,Amman,JordanAmaniG.Sa’diCommunityMedicine&PublicHealth,DepartmentofPublicHealthandCommunityMedicine,FacultyofMedicine,JordanUniversityofscienceandTechnology,Irbid,JordanYousefS.KhaderAuthorsKhansaT.AbabnehViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarManalJ.MaslamaniViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarMunaS.AbbadiViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarAnasH.TahaViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarJumanaA.KarasnehViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarAmaniG.Sa’diViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarYousefS.KhaderViewauthorpublicationsYoucanalsosearchforthisauthorin PubMed GoogleScholarContributionsKAandMMdraftedthemanuscript.KAistheprincipalinvestigatoranddesignedthestudy.KAandMMdevelopedthestudyprotocol.KA,MA,AT,JK,ASwereinvolvedinthedatacollectionaswell.YKwasinvolvedindataanalysis.Allauthorscriticallyreviewedandrevisedthemanuscript.Thefinalversionofthemanuscriptwasapprovedbyallauthors.CorrespondingauthorCorrespondenceto ManalJ.Maslamani.Ethicsdeclarations Ethicsapprovalandconsenttoparticipate ThisstudywasconductedinfullaccordancewithethicalprinciplesoftheWorldMedicalAssociationDeclarationofHelsinki. ApprovalforthisstudywasobtainedfromtheEthicalCommitteeintheDeanshipofScientificResearch,IRB,JUST,andinformedconsentformsforinterviewandexaminationweresignedbyallsubjectsandtheparentsofsubjectsundertheageof18 years. Consentforpublication Notapplicable. Competinginterests Theauthorsdeclarethattheyhavenoconflictofinterest. AdditionalinformationPublisher’sNoteSpringerNatureremainsneutralwithregardtojurisdictionalclaimsinpublishedmapsandinstitutionalaffiliations.Rightsandpermissions OpenAccessThisarticleisdistributedunderthetermsoftheCreativeCommonsAttribution4.0InternationalLicense(http://creativecommons.org/licenses/by/4.0/),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicense,andindicateifchangesweremade.TheCreativeCommonsPublicDomainDedicationwaiver(http://creativecommons.org/publicdomain/zero/1.0/)appliestothedatamadeavailableinthisarticle,unlessotherwisestated. ReprintsandPermissionsAboutthisarticleCitethisarticleAbabneh,K.T.,Maslamani,M.J.,Abbadi,M.S.etal.RiskindicatorsofaggressiveperiodontitisinaJordanianpopulation. BMCOralHealth19,155(2019).https://doi.org/10.1186/s12903-019-0826-1DownloadcitationReceived:18May2018Accepted:19June2019Published:16July2019DOI:https://doi.org/10.1186/s12903-019-0826-1SharethisarticleAnyoneyousharethefollowinglinkwithwillbeabletoreadthiscontent:GetshareablelinkSorry,ashareablelinkisnotcurrentlyavailableforthisarticle.Copytoclipboard ProvidedbytheSpringerNatureSharedItcontent-sharinginitiative KeywordsAggressiveperiodontitisRiskindicatorsJordan DownloadPDF Advertisement BMCOralHealth ISSN:1472-6831 Contactus Submissionenquiries:[email protected] Generalenquiries:[email protected]