Abstract
Gingival recession (GR) is considered a public health problem which is highly prevalent across different populations. Accuracy of psychometric properties of prevalence estimates of GR reported in epidemiological studies is important to facilitate setting public health goals, planning of public health programs, implementation of best practices and thereby developing public health policy. However, the reported prevalence estimates are influenced by the methodological variations among different studies, as observed in our recently published systematic review and meta-analysis on the global prevalence of GR. It substantially limits the comparability between studies and inferences about the true global variation in the prevalence of GR are difficult to establish. To address these issues, this commentary suggests to follow the standardized principles related to study design, clinical examination protocol, and characteristics of study subjects in future epidemiological studies on prevalence estimates of GR. Furthermore, the inclusion of additional domains in the reporting data is suggested for a deeper insight into the patterns of GR in different populations. Our suggestions are derived from a pragmatic approach and their consistent implementation would improve the reporting quality and achieve uniformity in future studies, thus benefitting the research in this area.
Keywords: Epidemiology, gingival recession, prevalence studies, report
INTRODUCTION
Gingival recession (GR) is the exposure of the root surface to the oral environment due to the apical migration of the gingiva in relation to the cementoenamel junction.[1] It is a potentially significant public health problem leading to esthetic and functional (dentinal hypersensitivity and difficulty in plaque control) impairment, and thereby negatively impacts a person’s oral health-related quality of life (OHRQoL).[2] It is a highly prevalent condition with varying patterns in different populations across the globe.[3] Several aspects of study design and clinical examination protocol can have an influence on its prevalence estimates. In addition, subject-related periodontal risk factors may further account for observed differences in the prevalence estimates across the studies. This may impede the comparison among different population-based studies or make it difficult to infer the true global variation in the prevalence of GR. Our recently published systematic review and meta-analysis on the worldwide prevalence of GR also revealed a conspicuous lack of homogeneity among the epidemiological studies and underscored the urgent need for a universally accepted standard protocol to report the GR prevalence.[3] Reporting of reliable data derived following standardized principles will not only facilitate the comparisons between GR prevalence estimates in different populations but would also help the public health policymakers in resource planning and sensitize the oral health-care personnel for early diagnosis, prevention, and need for interventional approaches.
The overall strength of evidence in our systematic review reporting the global prevalence of GR was determined using a Grading of Recommendations, Assessment, Development, and Evaluation approach[4] and found to be very low, the detailed process of which is described elsewhere.[3] Based on this systematically generated available evidence, this commentary aims to provide recommendations for reporting the prevalence of GR in future epidemiological studies in a standard format. It is hoped that it will improve the reporting quality, impart uniformity for meaningful comparisons of prevalence estimates across populations and provide insight into determinants of variation in the global prevalence of GR.
REPORTING STUDY DESIGN AND PARTICIPANTS’ CHARACTERISTICS
To ensure the accuracy and reliability of the prevalence estimates, it is critical to provide the key information related to the study design and characteristics of the study subjects. The standard principles of study design for reporting the prevalence of GR would be similar to any other prevalence study of a particular disease or condition as described elsewhere.[5,6] Briefly, the study should clearly report on the selection method of study participants (sampled from the general population or a specific subset of population), study settings (regional, national, or any other), and study period. The sampling frame and the reference population is a matter of concern in prevalence studies. It had been identified in the review process that most of the published studies reported the GR prevalence data derived from the convenience samples (patients attending the clinics, hospitals, or health care centers) which should not be considered representative of the general population.[7] Convenience sampling is a type of nonrandom or nonprobability sampling which is more likely to result in selection bias and under-or overestimation of the prevalence.[7] Looking at the dearth of data from representative samples, studies truly reflecting the prevalence of GR in the general population are highly warranted. Furthermore, the use of probability sampling is considered a fundamental prerequisite in prevalence studies.[5] Information on the sampling method (random, cluster, stratified, and multistage) for the recruitment of participants needs to be routinely reported.[5]
Based on the results of the methodological quality assessment of the different studies using a validated risk of bias tool in our review, it is suggested that the detailed process of selection of the participants in terms of sample size estimation, eligible population, excluded subjects at different stages (with numbers and reasons for noneligibility, nonparticipation, or lack of response), net sample size with respective response rate and finally the number of dentate individuals (after exclusion of edentulous participants) who will undergo periodontal examination, should be reported. If possible, the analysis of nonresponse data should be provided.[6]
Variations in the distribution of risk factor associated with GR among different populations is likely to account for the differences in prevalence across studies. We observed the lack of reporting or a clear definition for the potential risk factors such as race, ethnicity, living area (rural or urban), educational level, socioeconomic status, oral hygiene habits (brushing frequency, proximal cleaning, and brushing movement), tobacco usage (smokers or smokeless), smoking status, periodontal status, access to dental care, frequency of dental visits, and history of previous dental treatment. It is recommended that studies provide detailed information, possibly in a standardized manner, on the characteristics of the included subjects according to risk factors pooled for the whole study population to conduct multivariate risk analysis. Age and gender are the known determinants of GR but it was not possible for us to investigate the prevalence by age and gender due to inadequate data or variations in age groups among different studies. Prevalence estimates should be reported in total and stratified according to gender and 10-year age group.[6,8] The uniform stratification in age groups is suggested to maintain the comparability across populations: 15–24 years old, 25–34 years old, 35–44 years old, 45–54 years old, 55–64 years old, and 65–74 years old and ≥75 years old. Furthermore, peer-reviewed journals should encourage publishing the number of participants in each stratum, rather than the percentages only.
EXAMINATION PROTOCOLS
A standardized approach to record the GR in respondents must be used to obtain the reliable, valid, and comparable prevalence data for analysis. A high degree of heterogeneity observed in the review could have partly resulted from the methodological variations between the studies.
It is suggested that studies should use a valid method and calibrated instrument, usually a periodontal probe, to measure the GR as the distance from the cementoenamel junction to the free gingival margin, and self-reported or visual inspection methods are strongly discouraged. Although we included only those studies which used a valid method to record GR, the types of probes used varied considerably in the studies. The choice of a periodontal probe can affect the intra- or-interexaminer reliability and validity of measurements. It is therefore recommended that periodontal probes with fine and equidistant scales (e.g., marking at each millimeter), such as the University of North Carolina (UNC-15) probe should be used in epidemiological studies[9] as they offer high accuracy and expedite precise rounding of the measurements.[10] An identical probe should be used to record the measurements at all time points in a longitudinal study to avoid measurement bias. Furthermore, regular training and calibration sessions for the examiners involved in the epidemiological study are strongly suggested to ensure the reliability of data collected. Reporting Cohen’s Kappa statistics (for categorical variables) or inter/intra-class correlation coefficient (for continuous variables) to indicate agreement between examiners’ scoring is advised to facilitate the interpretation of data reliability.[5,6,9]
There is variation among the studies regarding the number of the sites examined per tooth (from 1 to 6) and the extent of the oral cavity examined, i.e., full-mouth versus partial-mouth (index teeth or half mouth) examination, to record the GR which limits the comparability. Although partial-mouth recording protocols (PRPs) and limiting the number of sites to be examined have the advantage of being quick, more subject compliant, and cost-effective, they have been reported to underestimate the prevalence of GR.[11,12] In our review, we performed the pooled analysis from studies which followed a full-mouth approach. A full-mouth examination protocol (FMP) measuring GR at 6 sites/tooth (MB-B-DB-ML-L-DL) on 28 teeth, excluding 3rd molars is suggested for clinical examinations.[12,13] When all 32 teeth are examined, comprehensive reporting of the data for both 28 and 32 teeth is recommended. Nevertheless, when the time and financial constraints are anticipated, PRP can be adopted provided a “correction factor” is calculated to account for possible differences between FMP and PRP, and enable comparison with other studies.
In the study selection phase of the review, it was observed that several studies did not report or had considerable variation in the threshold values/cutoff point at which the prevalence of GR was reported. Without a pertinent threshold value, reporting cannot be considered reliable and valid. We excluded the studies from inclusion in our review which reported the prevalence but did not define the GR threshold. A universally accepted definition based on the threshold of GR needs to be established in prevalence studies as any variations could potentially contribute to heterogeneity making it difficult to compare the results. It is recommended that future studies should report the prevalence of GR at a defined threshold, and also necessarily at ≥1 mm “cut off” to understand the actual burden of this condition.
ADDITIONAL DOMAINS TO BE CONSIDERED
Similar to periodontitis, there can be three epidemiologic measures to describe the GR. “Prevalence” is the percentage of population presenting with ≥1 site with GR at different GR depth thresholds at a specific point in time (point prevalence) or in a given period (period prevalence). “Extent” is the percentage of teeth affected by GR at various thresholds in subjects with GR. “Severity” describes the GR depth and usually reported as the mean depth in millimeters for different cut-offs. Reporting prevalence alone is of little value in understanding the epidemiology of GR and therefore information about the extent and severity of GR should be routinely reported [Supplementary Tables 1 and 2]. Furthermore, it is suggested that cross-sectional studies at two or more time points to determine trends, and cohort studies to determine the incidence and progression of GR should be conducted.
Supplementary Table 1.
Extent and severity of gingival recession at different cut-off values for all sites and buccal sites (all types)
| N | GR ≥1 mm | GR ≥3 mm | GR ≥5 mm | ||||
|---|---|---|---|---|---|---|---|
|
|
|
|
|||||
| All | Buccal | All | Buccal | All | Buccal | ||
| Total (number of teeth) | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Age groups | |||||||
| 15–24 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 25–34 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 35–44 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 45–54 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 55–64 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 65–74 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥75 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Gender | |||||||
| Male | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Female | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Education level (years) | |||||||
| Low (≤4) | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Middle (5–10) | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High (≥11) | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Socioeconomic status | |||||||
| Low | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Middle | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Living area | |||||||
| Rural | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Urban | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking behaviour | |||||||
| Nonsmoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Current smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Former smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smokeless tobacco | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking status | |||||||
| Light smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Moderate smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Heavy smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Tooth brushing frequency (days) | |||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Brushing movement | |||||||
| Vertical | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Horizontal | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Circular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Combination of the above | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Proximal cleaning (days) | |||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Frequency of dental visits | |||||||
| Regular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Irregular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| None | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Scaling frequency | |||||||
| ≤12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| >12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Never | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Orthodontic treatment | |||||||
| Yes | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| No | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Periodontal status | |||||||
| No periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage I periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage II periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage III/IV periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Severity | -mm (SE) | -mm (SE) | -mm (SE) | -mm (SE) | -mm (SE) | -mm (SE) | |
GR – Gingival recession; N – Number of teeth; SE – Standard error; % – Percentage of teeth; mm – Millimeter
Supplementary Table 2.
Extent and severity of gingival recession at different cut-off values for buccal sites (different types)
| N | GR ≥1 mm | GR ≥3 mm | GR ≥5 mm | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
||||||||
| RT1 | RT2 | RT3 | RT1 | RT2 | RT3 | RT1 | RT2 | RT3 | ||
| Total (number of teeth) | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Age groups | ||||||||||
| 15–24 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 25–34 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 35–44 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 45–54 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 55–64 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 65–74 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥75 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Gender | ||||||||||
| Male | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Female | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Education level | ||||||||||
| < high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| > high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Socioeconomic status | ||||||||||
| Low | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Middle | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Living area | ||||||||||
| Rural | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Urban | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking behaviour | ||||||||||
| Nonsmoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Current smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Former smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smokeless tobacco | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking status | ||||||||||
| Light smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Moderate smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Heavy smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Tooth brushing frequency (days) | ||||||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Brushing movement | ||||||||||
| Vertical | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Horizontal | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Circular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Combination of the above | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Proximal cleaning (days) | ||||||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Frequency of dental visits | ||||||||||
| Regular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Irregular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| None | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Scaling frequency | ||||||||||
| ≤12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| >12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Never | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Orthodontic treatment | ||||||||||
| Yes | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| No | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Periodontal status | ||||||||||
| No periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage I periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage II periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage III/IV periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Severity | -mm (SE) | -mm (SE) | -mm (SE) | -mm (SE) | -mm (SE) | -mm (SE) | -mm (SE) | -mm (SE) | -mm (SE) | |
GR – Gingival recession; N – Number of teeth; SE – Standard error; % – Percentage of teeth; RT – Recession type; mm – Millimeter
Buccal recessions may compromise the esthetics and holds a special attention from patients’ and clinicians’ perspective. Therefore, an additional analysis at subject-level [Supplementary Tables 3-6] and tooth level [Supplementary Tables 1, 2 and 7] for buccal recessions according to the types (all types and segregated) defined in 2018 classification system[14] in esthetic zone (between maxillary 2nd premolars) and whole mouth could be provided. Furthermore, data are lacking in the literature about the prevalence of single and multiple (percentage of individuals affected with a recession in a single tooth or multiple teeth) buccal GR and should be reported in future studies [Supplementary Tables 1 and 3].
Supplementary Table 3.
Prevalence of gingival recession (whole mouth) at different cut-off values for all sites and buccal sites (all types)
| N | GR ≥1 mm | GR ≥3 mm | GR ≥5 mm | Multiple GR (≥1 mm) | |||||
|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
|
||||||
| All | Buccal | All | Buccal | All | Buccal | All | Buccal | ||
| Total | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Age groups | |||||||||
| 15–24 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 25–34 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 35–44 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 45–54 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 55–64 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 65–74 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥75 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Gender | |||||||||
| Male | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Female | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Education level | |||||||||
| < high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| > high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Socioeconomic status | |||||||||
| Low | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Middle | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Living area | |||||||||
| Rural | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Urban | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking behaviour | |||||||||
| Nonsmoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Current smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Former smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smokeless tobacco | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking status | |||||||||
| Light smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Moderate smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Heavy smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Tooth brushing frequency (days) | |||||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Brushing movement | |||||||||
| Vertical | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Horizontal | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Circular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Combination of the above | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Proximal cleaning (days) | |||||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Frequency of dental visits | |||||||||
| Regular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Irregular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| None | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Scaling frequency | |||||||||
| ≤12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| >12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Never | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Orthodontic treatment | |||||||||
| Yes | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| No | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Periodontal status | |||||||||
| No periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage I periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage II periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage III/IV periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
GR – Gingival recession; N – Number of participants; SE – Standard error; % – Percentage of population
Supplementary Table 6.
Prevalence of buccal gingival recession (different types) in esthetic zone (15–25; FDI) at different cut off values
| N | GR ≥1 mm | GR ≥3 mm | GR ≥5 mm | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
||||||||
| RT1 | RT2 | RT3 | RT1 | RT2 | RT3 | RT1 | RT2 | RT3 | ||
| Total | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Age groups | ||||||||||
| 15–24 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 25–34 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 35–44 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 45–54 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 55–64 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 65–74 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥75 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Gender | ||||||||||
| Male | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Female | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Education level | ||||||||||
| < high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| > high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Socioeconomic status | ||||||||||
| Low | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Middle | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Living area | ||||||||||
| Rural | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Urban | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking behavior | ||||||||||
| Nonsmoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Current smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Former smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smokeless tobacco | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking status | ||||||||||
| Light smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Moderate smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Heavy smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Tooth brushing frequency (days) | ||||||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Brushing movement | ||||||||||
| Vertical | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Horizontal | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Circular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Combination of the above | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Proximal cleaning (days) | ||||||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Frequency of dental visits | ||||||||||
| Regular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Irregular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| None | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Scaling frequency | ||||||||||
| ≤12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| >12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Never | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Orthodontic treatment | ||||||||||
| Yes | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| No | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Periodontal status | ||||||||||
| No periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage I periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage II periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage III/IV periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
GR – Gingival recession; N – Number of participants; SE – Standard error; % – Percentage of population; FDI – Fédération Dentaire Internationale numbering system; RT – Recession types
Supplementary Table 7.
Prevalence of gingival recession according to tooth type for all sites and buccal sites (all types and segregated)
| N | All sites | Buccal sites | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
|
| |||||||||||
| All types | RT1 | RT2 | RT3 | ||||||||
|
|
|
|
|
|
|||||||
| GR ≥ 1 mm | GR ≥ 3 mm | GR ≥ 1 mm | GR ≥ 3 mm | GR ≥ 1 mm | GR≥ 3 mm | GR ≥ 1 mm | GR ≥ 3 mm | GR ≥ 1 mm | GR ≥ 3 mm | ||
| Total | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Tooth type (FDI) | |||||||||||
| 11 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 12 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 13 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 14 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 15 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 16 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 17 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 21 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 22 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 23 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 24 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 25 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 26 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 27 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 31 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 32 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 33 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 34 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 35 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 36 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 37 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 41 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 42 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 43 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 44 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 45 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 46 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 47 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | ||
| N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | ||
| N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | ||
| N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | ||
| Arch | |||||||||||
| Maxilla | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Mandible | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Arch side | |||||||||||
| Right | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Left | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Severity | --mm (SE) | --mm (SE) | --mm (SE) | --mm (SE) | --mm (SE) | --mm (SE) | --mm (SE) | --mm (SE) | --mm (SE) | --mm (SE) | |
GR – Gingival recession; N – Number of teeth; SE – Standard error; % – Percentage of teeth; FDI – Fédération Dentaire Internationale numbering system; RT – Recession type
Supplementary Table 4.
Prevalence of gingival recession (whole mouth) at different cut-off values for buccal sites (different types)
| N | GR ≥1 mm | GR ≥3 mm | GR ≥5 mm | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
|
|
|
|
||||||||
| RT1 | RT2 | RT3 | RT1 | RT2 | RT3 | RT1 | RT2 | RT3 | ||
| Total | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Age groups | ||||||||||
| 15–24 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 25–34 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 35–44 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 45–54 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 55–64 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 65–74 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥75 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Gender | ||||||||||
| Male | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Female | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Education level | ||||||||||
| < high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| > high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Socioeconomic status | ||||||||||
| Low | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Middle | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Living area | ||||||||||
| Rural | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Urban | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking behaviour | ||||||||||
| Nonsmoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Current smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Former smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smokeless tobacco | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking status | ||||||||||
| Light smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Moderate smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Heavy smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Tooth brushing frequency (days) | ||||||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Brushing movement | ||||||||||
| Vertical | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Horizontal | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Circular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Combination of the above | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Proximal cleaning (days) | ||||||||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Frequency of dental visits | ||||||||||
| Regular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Irregular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| None | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Scaling frequency | ||||||||||
| ≤12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| >12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Never | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Orthodontic treatment | ||||||||||
| Yes | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| No | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Periodontal status | ||||||||||
| No periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage I periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage II periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage III/IV periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
GR – Gingival recession; N – Number of participants; SE – Standard error; % – Percentage of population; RT – Recession type
Supplementary Table 5.
Prevalence of buccal gingival recession (all types) in esthetic zone (15–25; FDI) at different cut off values
| N | GR ≥1 mm | GR ≥3 mm | GR ≥5 mm | Multiple GR ≥1 mm | |
|---|---|---|---|---|---|
| Total | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Age groups | |||||
| 15–24 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 25–34 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 35–44 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 45–54 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 55–64 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 65–74 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥75 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Gender | |||||
| Male | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Female | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Education level | |||||
| < high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| > high school | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Socioeconomic status | |||||
| Low | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Middle | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| High | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Living area | |||||
| Rural | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Urban | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking behaviour | |||||
| Nonsmoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Current Smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Former smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smokeless tobacco | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Smoking status | |||||
| Light smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Moderate smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Heavy smoker | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Toothbrushing frequency (days) | |||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Brushing movement | |||||
| Vertical | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Horizontal | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Circular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Combination of the above | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Proximal cleaning (days) | |||||
| ≤1 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| 2 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| ≥3 | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Frequency of dental visits | |||||
| Regular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Irregular | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| None | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Scaling frequency | |||||
| ≤12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| >12 months | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Never | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Orthodontic treatment | |||||
| Yes | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| No | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Periodontal status | |||||
| No periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage I periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage II periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
| Stage III/IV periodontitis | N | N (%, SE) | N (%, SE) | N (%, SE) | N (%, SE) |
GR – Gingival recession; N – Number of participants; SE – Standard error; % – Percentage of population; FDI – Fédération Dentaire Internationale numbering system
Reporting the prevalence of GR at tooth level (tooth type) for all sites and buccal sites which is further divided according to recession types (RT1, RT2, RT3) will provide insight into the teeth commonly affected with GR [Supplementary Table 7] and the teeth amenable for root coverage. GR occurs due to tissue destruction from periodontitis in most of the individuals, it is either untreatable or have reduced potential for complete root coverage due to interproximal attachment loss.[15] It should also be mentioned that despite being a highly prevalent condition, most of the GRs are asymptomatic and/or not perceived by the individuals, inferring that the actual need for treatment could be very low.[16]
Complying with the Ottawa Charter[17] on oral health promotion, it is important that the people’s health is placed in people’s hands. Esthetic impairment and hypersensitivity may be caused by GR and it may affect the OHRQoL of the patients.[2] Quality of life has a huge impact on individual perception and translating a problem into as public health issue. It has been stated that the acceptance of treatment increased if the patients had complaints regarding their GR.[18] Furthermore, such aware patients preferred more of noninvasive procedures as their treatment options compared to invasive ones. Therefore, it is suggested that the recording of OHRQoL along with demographic and clinical data in standardizing GR research protocol studies will get a complete profile of the patient, community, nation, and world at large.
The database of GR generated from various prevalence studies can be compiled in systematic reviews and meta-analyses through various models described in an integrative meta-regression framework.[19] For instance, DisMod-MR, a Bayesian meta-regression tool from the Global Burden of Disease 2010 Study,[19] combines age integrating compartmental model of disease with covariates that predict variation in true rates; covariates that predict variation across studies due to age-specific fixed effects; super-region, region, and country random intercepts and measurement bias. To further explore the influence of demographic and epidemiological factors on the burden (number of prevalent cases) of GR, decomposition analysis[20] may be performed.
SUMMARY
The recommendations being derived empirically from our systematic review may be subjected to limitations and constraints of the data reviewed. Nevertheless, the implementation of these recommendations can help the researchers and epidemiologists in this field to report the information in a standardized format, thereby improving the reporting quality and enhancing the comparability of GR prevalence estimates across the studies. To summarize, the following aspects in a future epidemiological study on GR should be considered:
Well-designed and standardized studies representative of general population from several countries is highly needed for accurately estimating the global prevalence of GR
To minimize the risk of bias in a study, study design, sample size, sampling techniques, recording protocols, and statistical analysis should be comprehensively reported
Prevalence estimates of GR should be reported in total and in each stratum or subgroups
A “full-mouth examination” approach involving all the six surfaces of a tooth using a UNC-15 probe at a severity threshold of ≥1 mm would be advised in future studies to understand the actual burden of the GR
Incorporation of additional domains along with standard reporting protocols will allow a better understanding of the epidemiology of GR.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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