Periodontal Status and Risk Factors of a Vulnerable Low-Income Community in Edmonton

Background: Periodontal disease is one of the most prevalent non-communicable diseases worldwide and a leading cause of tooth loss. It is strongly influenced by modifiable risk factors including smoking, substance use, and social determinants of health such as income, education, and access to care. While previous studies have established this link globally, Canadian data remains sparse, particularly regarding vulnerable inner-city populations. This study aimed to address this knowledge gap by assessing the periodontal health of individuals in Edmonton’s Boyle McCauley Street community, a population characterized by socioeconomic vulnerability. Methods: This was a population-based, cross-sectional study involving 322 adults recruited from four community organizations serving vulnerable Edmontonians. Data was collected via structured questionnaires and clinical oral examinations. Descriptive statistics showcased the population’s socio-demographic, behavioral, as well as general and oral health parameters. Given the dataset’s complexity, additional statistical methods were employed to identify factors associated with periodontal status, as defined by average probing depth and average interproximal probing depths of the six index Ramfjord teeth. To manage missing data and reduce modeling bias, multiple imputation using the Predictive Mean Matching (PMM) was performed. Variable filtering and collinearity checks were conducted to reduce dimensionality, followed by variable selection using LASSO (Least Absolute Shrinkage and Selection Operator) regression via the HierNet algorithm. Separate models were constructed for total average probing depth and interproximal depth to account for site-specific periodontal involvement. Final variable selection used backward elimination with pooled estimates from the multiple imputations. Results: The cohort had a mean age of 49 years, was predominantly male (71%), and overwhelmingly unemployed (89%), with only 24% earning over $12,000 annually. High-risk behaviors were widespread: 69% smoked, 53% consumed alcohol regularly, and 56% used recreational drugs. Only 36% had seen a dentist in the past year, and 9% were fully edentulous. Mucosal inflammation and soft tissue lesions were identified in over half of the participants, and the average DMFT (Decayed, Missing, and Filled Teeth) index was 13.3, indicating a high caries experience. Multivariate regression identified several statistically significant associations with increased periodontal probing depths. First, individuals presenting with pink or white mucosal lesions demonstrated significantly altered probing depths suggesting a potential link between periodontal inflammation and mucosal pathology. Second, participants who reported esthetic or functional oral limitations (e.g., impaired speech or appearance concerns) had worse periodontal outcomes, indicating that subjective perceptions may correlate with underlying disease. Third, individuals self-identifying as “Other” ethnicity (non-White, non-Indigenous) showed slightly but significantly higher probing depths than other ethnic groups, suggesting potential racial variations in periodontal health. Contrary to expectations, no statistically significant associations were observed with traditionally recognized risk factors such as smoking status, income, or education. This is likely attributable to the cohort’s overall homogeneity in low socioeconomic status and high-risk behaviors, which may have limited variability and statistical contrast. Conclusion: This study provided a detailed snapshot of the periodontal and oral health landscape within one of Edmonton’s most underserved communities. It highlights the overwhelming burden of disease and unmet need in a population where access to care is severely limited and risk factors are widespread. The results emphasize the importance of integrating oral health with broader community health initiatives, particularly in vulnerable communities. From a research perspective, the study demonstrates the utility of advanced modeling strategies including multiple imputation, dimensionality reduction, and penalized regression in maximizing the value of complex, imperfect real-world datasets. Clinically, it suggests that patient-reported oral health concerns and visible mucosal changes may potentially serve as screening indicators for periodontal disease in resource-limited settings. Future studies should explore these associations in more diverse and representative populations, and ideally adopt longitudinal designs to examine causality and disease progression. The implementation of programs like the Canadian Dental Care Plan (CDCP) provides a unique opportunity to revisit these communities in future years and assess the impact of expanded public dental coverage on periodontal outcomes. In sum, this research contributes critical insight to the Canadian literature on oral health equity and offers a foundation for targeted interventions in high-risk populations.

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