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Original Research
Prevalence of anterior gingival recession
and related factors among Saudi adolescent
males in Abha City, Aseer Region, Saudi
Arabia
Hossam A. Eid

Department of
Oral Medicine and
Periodontology, Faculty
of Dentistry, Suez Canal
University, Ismailia,
Egypt, and Division of
Periodontics, Department
of Preventive Dental
Sciences, College of
Dentistry, King Khalid
University, Abha,
Kingdom of Saudi Arabia
Address for correspondence:
Dr. Hossam A. Eid,
E-mail:
hossam_eid73@yahoo.com
ABSTRACT
Background: Gingival recessions (GR) are asymptomatic and develop slowly, it can be localized or generalized,
and be associated with one or more surfaces. Age is a variable that several authors have found associated with
gingival recession. This study aimed to evaluate gingival recession clinically and related variables in a population
of Saudi adolescent males, Southwestern of Saudi Arabia. Materials and Methods: A cross‑sectional study was
carried out on 250 Saudi adolescent males aged between 12 and 18 years. All periodontal clinical examinations
were assessed using University of Michigan ‘0’ probe with William’s markings, a dental chair and one examiner.
Questionnaires were used to collect diverse risk‑related factors. Statistical analysis of the results was accomplished
using Chi‑square test (α = 0.05). Results: Out of 250 patients, 73.00% ± 8.97% were presented with gingival
recession (GR) and 27.00% ± 4.11% without GR. The highest number 56 (22.4%) of patients were presented with
GR and 8.4% without GR in the age group of 14 years. Then chronologically, 17.6% and 9.6%, 16.4% and 0.4%, 12.4%
and 1.6%, and 0.8% and 0% patients were evident with and without GR of 15‑, 17‑, 16‑ and 18‑years age groups,
respectively. 22.25% ± 42.52% patients had GR in the upper left central incisors. Whereas, 17.25% ±  15.52%,
11.75% ± 17.48%, and 1.5% ± 1.91% patients were presented with GR in upper right central incisors, upper‑left
lateral incisors and upper‑right lateral incisors, respectively. 50.4% ± 3.63% and 1.2% ± 0.31% having or not GR,
respectively, who were not cleaning teeth at all. Toothbrush users had GR 28.8% ± 4.52% and 18% ± 2.84%
without GR. Miswak and both aids users had or not GR were 18.8% ± 3.35%, 0.4% ± 0.15%, and 3.2% ± 0.49%
and 4.4% ±1.13%, respectively. (51.6% ± 7.29%) of patients had GR without anterior crowding rather than the
patients with anterior crowding (21.2 ± 3.49%). The highest percentage (38.4% ± 5.95%) of patients had GR
having normal frenal attachments (Grade 0), whereas, in Grade 2, 1, and 3, patients had GR 34.8% ± 4.68%,
23.6% ± 3.08%, and 13.6% ± 2.20%, respectively. Interestingly, GRs were present in all patients who had habits
of both smoking and tobacco use (8.4% ± 2.83%). Conclusion: The results of this study proved that neglecting
oral hygiene is the most common cause behind increase the gingival recession among adolescents.
KEY WORDS: Gingival recession, Adolescents, Saudi Arabia, southwestern region

Introduction to the cementoenamel junction (CEJ). It may be localized

or generalized and can be associated with one or more tooth

G ingival recession is the exposure of the root surface

resulting from migration of the gingival margin apical
surfaces.[1] The etiology of the condition is multifactorial
and may include plaque‑induced inflammation, calculus
and restorative iatrogenic factors, trauma from improper oral
Access this article online hygiene practices, tooth malpositions, high frenum attachment,
Quick Response Code: improper periodontal treatment procedures, and uncontrolled
Website: orthodontics movements.[2,3]
www.jdrr.org

Epidemiological studies show that more than 50% of subjects

DOI: in the populations studied have one or more sites with
10.4103/2348-3172.126160 recession of at least 1 mm, buccal sites being most commonly
affected. Higher levels of recession have been found in males

How to cite this article: Eid HE. Prevalence of anterior gingival recession and related factors among Saudi adolescent males in Abha City, Aseer Region, Saudi
Arabia. J Dent Res Rev 2014;1:18-23.

 18 Journal of Dental Research and Review ● Jan-Apr 2014 ● Vol. 1 ● Issue 1

[Downloaded free from http://www.jdrr.org on Tuesday, July 3, 2018, IP: 180.246.40.6]

Eid: Prevalence of anterior ginival recession among Saudi adolescent males

than females.[4] Recession at the buccal surfaces is common
in populations with good oral hygiene[5‑7] whereas with poor
standards of oral hygiene it may affect other tooth surfaces.[8]
Gingival recession at the lingual surfaces of lower anterior teeth
showed a strong association with the presence of supragingival
and subgingival calculus.[9]
Even though gingival recession may occur without any
symptoms it can give rise to pain from exposed dentine,
patient concern about loss of the tooth, poor esthetics or root
caries. The denuded root surfaces cause deterioration in the
esthetic appearance, dentin hypersensitivity, and inability to
perform proper oral hygiene procedures.[10,11] A relatively high
prevalence of gingival recession among adults in Tanzania has
been reported.[12,13] Gingival recession on buccal surfaces has
been ascribed to brushing habits.[13‑15] Since the lingual surfaces
in the Tanzanian population exhibits gingival recession to the
same extent as the buccal surfaces,[12,13] then it is doubtful
that the Miswak is the cause of high prevalence of gingival
recession.[14‑17] Younes and El‑Angbawi reported that about
22% of the Saudi schoolchildren with gingival recession used
Miswak.[18] The low percentage of calculus deposits found in
the group affected by gingival recession may be due to the
common use of Miswak.[14‑17] It has been reported that Miswak
users had significantly more sites of gingival recession than
did the toothbrush users. Furthermore, the severity of the
recession was significantly more pronounced in the Miswak
users than that in the toothbrush users.[14‑17] However, the
gingival recession reported in Miswak users may be a reflection
of poor techniques.[18-20] This study was performed in Abha
city, Aseer region, southwestern Saudi Arabia which extends
from the high mountains of Sarawat (with an altitude of 3,200 
m above the sea level) to the Red Sea; this unique area of the
world is characterized by population using Miswak besides tooth
brushing side by side in oral hygiene maintenance which gave us
a good chance to study the effect of Miswak on gingival recession
with the other parameters of our study. This study has important
limitations because the sample was not randomly selected from
the Saudi population but consisted of patients that visited a
private dental practice for their regular dental follow‑up in
college of dentistry, KKU. Up to our knowledge similar studies
have not been carried out in the Abha city, Aseer region, due
to which data from the present study are only comparable to
those reported for similar studies that were carried out in other
countries and in other cities of the Saudi Arabia.
Aim of the study
the study through questionnaire approved from ethical research
committee of college of Dentistry, KKU. Data were collected
from February, 2013 to June 10, 2013. Dental examinations
were carried out using interchangeable plane mouth mirrors and
University of Michigan ‘0’ probe with William’s markings were
used to measure the clinical crown length of the affected and
adjacent teeth. Volchansky and Cleaton Jones stated that the
clinical crown height is an objective measure of the position of
gingival margin which could be used in determining the ‘normal
position’ of the gingival margin.[21] Measurements were made at
the labial midline from the gingival crest to the cementoenamel
junction (CEJ). Periodontal diseases were indexed as plaque
index (PI), gingival index (GI), calculus index (CI), and clinical
attachment loss (CAL) after Loe[22] and modified from Russel.[23]
For anterior crowdings, the position of each mandibular central
incisor was classified according to its relationship to the regular
curve of the arch as described by Stoner and Mazdyasma
where 0 = correctly positioned or instanding and 1 = tooth
was labially placed or absent.[24] Frenal involvements in the
affected and adjacent teeth were recorded according to the
classification of Powell and McEniery, accordingly, 0 = no
frenal involvement, 1 = frenal insertion close to the gingival
margin but no retraction of gingiva, 2 = narrow frenal insertion
with retraction of gingiva, 3 = broad frenal insertion with
retraction of gingiva.[25]
Data analysis
Statistical analysis of the results was accomplished using
Chi‑square test (α =0.05).
Results
Out of 250 patients, 73.00% ± 8.97% were presented with
gingival recession (GR) and 27.00% ± 4.11% without GR.
Table 1 showed that among 250 patients, the majority (30.8%)
of the patients were examined under 14‑, 15‑, 17‑, 16‑ and
13‑years age groups. Only 2.4% and 0.8% patients were examined
under the age groups of 12‑ and 18‑years, respectively. The
highest number 56 (22.4%) of patients were presented with
GR and 8.4% without GR in the age group of 14 years. Then
chronologically, 17.6% and 9.6%, 16.4% and 0.4%, 12.4% and
1.6%, and 0.8% and 0% patients were evident with and without
GR of 15‑, 17‑, 16‑ and 18‑years age groups, respectively. Twelve

The study aimed to determine the most common causative Table 1: Age‑wise frequencies of gingival recession
factors and prevalence of gingival recession among Saudi Age Total pt. Pt. count (%) Pt. count (%)
adolescent males aged between 12 and 18 years in Abha city, years count (%) with GR without GR
Aseer region of Saudi Arabia. 12 6 (2.4) 4 (1.6) 2 (0.8)
13 20 (8) 4 (1.6) 16 (6.4)
14 77 (30.8) 56 (22.4) 21 (8.4)
Materials and Methods 15 68 (27.2) 44 (17.6) 24 (9.6)
16 35 (14) 31 (12.4) 4 (1.6)
A cross‑sectional study was carried out on (250) Saudi adolescent 17 42 (16.8) 41 (16.4) 1 (0.4)
males; the males were examined in the dental clinics, college of 18 2 (0.8) 2 (0.8) 0
Dentistry, KKU, Abha city of Saudi Arabia. Verbal consent for Total 250 (100) 182 (73) 68 (27)
data collection obtained from the individuals who participated in pt.: Patient ;GR: Gingival recession

Journal of Dental Research and Review ● Jan-Apr 2014 ● Vol. 1 ● Issue 1 19 

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Eid: Prevalence of anterior ginival recession among Saudi adolescent males
and 13‑years age groups showed 1.6% of each having GR and
0.8% and 6.4% without GR, respectively.
Figure 1a showed that 22.25% ± 42.52% patients had GR in the
upper‑left central incisors. Whereas, 17.25% ± 15.52%, 11.75%  ±
17.48%, and 1.5% ±1.91% patients were presented with GR in
the upper‑right central incisors, upper‑left lateral incisors, and
upper‑right lateral incisors, respectively. GR were not evident in
any patients in either canine of upper jaws. On the other hand,
Figure 1b is presenting that majority (20.25% ± 24.20%) of the
patients had GR in the lower right central incisors. The lower‑left
incisors, lower‑right and left canines, lower‑right lateral incisors
and lower‑left lateral incisors having GR 10.25% ± 15.48%, 3.0% ±
5.35% and 3.0 ± 4.08%, 2.5 ± 2.38% and 2.0 ± 3.37%, respectively.
Figure 2 presented with the majority (46% ± 6.81%) of
the patients were cleaning their teeth using toothbrush,
whereas, 22% ± 3.43%, Miswak and 4.8% ± 1.10% were using
both (toothbrush and Miswak) aids. A considerable number of
patients (26.4% ± 3.63%) were not cleaning their teeth at all.
Figure 3 is showing that the 50.4% ± 3.63% and 1.2% ± 0.31%
having or not GR, respectively, who were not cleaning teeth at
all. Toothbrush users had GR 28.8% ± 4.52% and 18% ± 2.84%
without GR. Miswak and both aids users had or not GR
were 18.8% ± 3.35%, 0.4% ± 0.15% and 3.2% ± 0.49% and
4.4% ± 1.13%, respectively.
Figure 4 is presenting the fact that more numbers (51.6% ± 7.29%)
of patients had GR without anterior crowding rather than the
patients with anterior crowding (21.2% ± 3.49%). In the absence
of anterior crowding, patients without GR (14.8% ± 2.28%) had
slightly more (12.4% ± 2.61%) than with anterior crowding.
Figure 5 showed that the highest percentage (38.4% ± 5.95%)
of patients had GR having normal frenal attachments (Grade 0),
whereas, in Grade 2, 1, and 3, patients had GR 34.8% ± 4.68%,
23.6% ± 3.08% and 13.6% ± 2.20%, respectively.
In Figure 6, the majority of the patients had GR 39.2% ± 5.11%
having frenal positions on the lower lateral incisors and
 






 
 
85 85 85 8/ 8/ 8/
a b
Figure 1: Tooth-wise frequencies of gingival recession N.B.: UR1: Upper‑right central incisor, UR2: Upper‑right lateral incisor, UR3: Upper‑right
canine, UL1: Upper‑left central incisor, UL2: Upper‑left lateral incisor, UL3: Upper‑left canine, LR1: Lower‑right central incisor, LR2: Lower‑right
lateral incisor, LR3: Lower‑right canine, LL1: Lower‑left central incisor, LL2: Lower‑left lateral incisor, LL3: Lower‑left canine
 20 Journal of Dental Research and Review ● Jan-Apr 2014 ● Vol. 1 ● Issue 1
29.6% ± 8.29% GR where the frenal positions were normal. In
other cases, chronologically GR were found 14.4% ± 2.71% in
upper lateral incisors, 13.6% ±2.20% in upper central incisors,
8.4% ± 1.4% in lower central incisors, 2.8% ± 1.06% in upper
canines and 0.8% ± 0.2% in lower canines.
Figure 7 showed the personal habits of the patients and the
occurrences of GRs. Only smokers (13.2% ± 1.83%) had GR
7.2% ± 1.13% and 6.0% ± 1.02% had no GR. Among the tobacco
users (8.8% ± 1.72%), 8.0% ± 1.59%, and 0.8% ± 0.2% had
GR and no GR, respectively. Interestingly, GRs were present
in all patients who had habits of both smoking and tobacco
use (8.4% ± 2.83%).
Discussion
Localized gingival recession occasionally presents a problem
in adolescents and there is some confusion regarding the
etiology and pathogenesis of such defects.[14‑19] Marginal tissue
recession can cause major functional and esthetic problems.
Interproximal recession creates space in which plaque, food,
and bacteria can accumulate.[10,11] Hyperemia of the pulp and
associated symptoms may also result from exposure of the
root surface.[20,25] Periodontal health can be evaluated through
different indicators including gingival recession[26] Its etiology
is determined by a number of predisposing and precipitating
factors. [26,27] Predisposing factors may be anatomical or
associated with occlusal trauma. The anatomical include
poorly adhered gingiva, tooth malposition and crowding, root
prominence, and bone defects. Those associated with occlusal
trauma are related to the intensity and duration of trauma. In
contrast, precipitating factors are a series of sociodemographic,
socioeconomic, and environmental issues. Some studies have
observed that gingival recession was associated with sex, number
of teeth present, bleeding on probing (BOP), the presence or
absence of systemic disease(s), use of dentures, and use of
alcohol and tobacco,[27] or with inflammation measurements
such as presence of plaque.[28] Pires et al.[29] reported that the
presence of gingival recession in the anterior lingual mandibular
region of a young population was associated with the use of
piercings, age, male gender, and BOP. According to the results



 

  

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Eid: Prevalence of anterior ginival recession among Saudi adolescent males


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Figure 4: Relationship of anterior crowding and GR
of this study proved that gingival recession is multifactorial
condition, the highest number 56 (22.4%) of patients were
presented with GR and 8.4% without GR in the age group of
14 years, which may be due to neglecting oral hygiene at this
age group. 22.25% ± 42.52% patients had GR in the upper‑left
central incisors. Whereas, 17.25% ± 15.52%, 11.75% ± 17.48%,
and 1.5% ± 1.91% patients were presented with GR in
upper‑right central incisors, upper‑left lateral incisors, and
upper‑right lateral incisors, respectively, which may be due
faulty brushing that exerts detrimental forces on marginal
gingiva with subsequent gingival recession. Miswak and both
aids users had or not GR were 18.8% ± 3.35%, 0.4% ± 0.15%
and 3.2% ± 0.49% and 4.4 ± 1.13%, respectively (51.6 ± 7.29%)
of patients had GR without anterior crowding rather than
the patients with anterior crowding (21.2% ± 3.49%). The
highest percentage (38.4% ± 5.95%) of patients had GR having
normal frenal attachments (Grade 0), whereas, in Grade 2,
1 and 3, patients had GR 34.8% ± 4.68%, 23.6% ± 3.08%,
and 13.6% ± 2.20%, respectively. Interestingly, GRs were
present in all patients who had habits of both smoking and
tobacco use (8.4% ± 2.83%). The results of this study similar
in some of its aspects to a study done by Younes, Angbawi[18]
who stated that Incidence of gingival recession in the
Journal of Dental Research and Review ● Jan-Apr 2014 ● Vol. 1 ● Issue 1 21 
*UDGH *UDGH *UDGH *UDGH
Figure 5: Relationship of frenal attachment gradings and GR
mandibular central incisor region was examined in a sample
of 1336 male and female Saudi school children aged between
10 and 15 years. Gingival recession was found in 9.88%
with no significant difference in the affected teeth by age
(P greater than 0.8361). There was a significant difference
in the mean clinical crown length between the affected and
adjacent teeth (P less than 0.0001). The highest significant
association of gingival recession was found with inflammation
(P less than 0.0001), anterior crowding (P less than 0.0009) and
frenal involvement (P less than 0.0001). Another recent study
by Chrysanthakopoulos[30] said that gingival inflammation, as
determined by the gingival index, and smoking were the most
important associated risk factors of GR. Turkish recent study
by Toker, Ozdemir[31] concluded that high level of gingival
recession in this population is significantly associated with a
high level of dental plaque and calculus, male gender, smoking
duration, tooth brushing frequency, traumatic tooth brushing
and high frenum. The majority of studies including the recent
ones reach to the same conclusion in all age groups of population
about the most causative factor of gingival recession is the bad
oral hygiene besides other causative factors as teeth crowding,
frenal attachment, tooth brushing, bad oral habits to a lesser
extent.
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Eid: Prevalence of anterior ginival recession among Saudi adolescent males





 






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Figure 6: Relationship of frenal attachment positions and GR N.B.: 0 (%)‑normal frenal position

 


   







 


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Figure 7: Habits and GR
Conclusion
The results of this study proved that neglecting oral hygiene is
the most common cause behind increase the gingival recession
among adolescents. The designation of educational program
for periodontal health care is mandatory to decrease the risk of
gingival recession among population specially the adolescents.
Acknowledgement
The Author express their gratitude and acknowledgement to Dr. Nazar
Omer Abdallah, Asst. Professor, Dept. of Business Administration,
College of Community, KKU for his cordial assistance in analyzing
the data.
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Source of Support: Nil, Conflict of Interest: None declared.

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3) Images:
Submit good quality color images. Each image should be less than 4096 kb (4 MB) in size. The size of the image can be reduced by decreas-
ing the actual height and width of the images (keep up to about 6 inches and up to about 1800 x 1200 pixels). JPEG is the most suitable
file format. The image quality should be good enough to judge the scientific value of the image. For the purpose of printing, always retain a
good quality, high resolution image. This high resolution image should be sent to the editorial office at the time of sending a revised article.
4) Legends:
Legends for the figures/images should be included at the end of the article file.

Journal of Dental Research and Review ● Jan-Apr 2014 ● Vol. 1 ● Issue 1 23 