Ethnic Disparities in the Prevalence of Periodontitis Among High School Students in Sudan Amal M. Elamin,* † Nils Skaug, ‡ Raouf W. Ali, † Vidar Bakken,* and Jasim M. Albandar § Background: There are limited data on the epidemiology and risk factors of periodontitis in young populations in devel- oping nations. This study assesses the prevalence of peri- odontal attachment loss and aggressive periodontitis and the association with ethnicity among high school students in Sudan. Methods: The study sample consisted of 1,200 students, 13 to 19 years old, selected from 38 public and private high schools using a multistage, stratified sampling design. The subjects were interviewed and examined clinically. Periodon- tal parameters were assessed at six sites per tooth. Subjects with aggressive periodontitis were identified. Results: A total of 3.4% of the subjects had aggressive peri- odontitis, and 16.3% and 8.2% of the subjects had at least one tooth with ‡4 and ‡5 mm attachment loss, respectively. A significantly higher percentage of subjects of African tribal ethnicity had attachment loss ‡4 and ‡5 mm compared to Afro-Arab tribes (19.8% versus 14.7%, P = 0.02; and 12% ver- sus 6.4%, P = 0.004, respectively), and had a higher preva- lence of aggressive periodontitis (6% versus 2.3%; P = 0.01) and higher risk of being diagnosed with this disease (odds ratio = 2.7; P <0.0001). African ethnicity was also associated with a significantly higher number of teeth with attachment loss than in Afro-Arabs (P <0.01). Comparison by gender showed a significantly higher percentage of males with aggressive periodontitis (4.9% versus 2%; P <0.01) and a higher risk for this disease (odds ratio = 2.5; P = 0.01) than in females. How- ever, the prevalence of subjects with attachment loss ‡4 and ‡5 mm was comparable in the two gender groups. Conclusions: Our results show that aggressive periodontitis is highly prevalent in this population. African ethnicity (versus Afro-Arab) and male gender were risk factors for aggressive periodontitis. J Periodontol 2010;81:891-896. KEY WORDS Aggressive periodontitis; continental population groups; ethnology; gender identity; periodontal attachment loss; periodontal diseases. A ggressive periodontitis is an in- fectious disease of the supporting tissues of the tooth characterized by a rapid disease progression; it often re- sults in early loss of the affected teeth. 1-3 This disease mainly affects adolescents and young subjects, although older age groups may also be affected. Several studies have shown that the prevalence of aggressive periodontitis varies signif- icantly in different parts of the world. 4,5 The prevalence is generally high in Afri- can countries and in individuals of African descent, although high prevalence rates have also been reported in other pop- ulations. 6,7 According to Albandar and Tinoco, 4 the prevalence of aggressive periodontitis in Africa ranges between 0.5% and 5%. Other forms of periodontitis are also seen in young subjects, including chronic periodontitis and periodontitis associated with systemic diseases. Spe- cific bacteria, immune defects, genetic predisposition, and socioeconomic fac- tors are thought to play major roles in the initiation and progression of attachment loss in aggressive periodontitis. Few studies have investigated the ef- fect of race and ethnicity on the preva- lence of periodontal disease. National surveys in the United States clearly show that race is a significant risk factor for chronic and aggressive periodontitis in adults and children. 8,9 Various ethnic and racial groups within the same geo- graphic location often differ in many as- pects, such as knowledge regarding oral * The Gade Institute, Section for Microbiology and Immunology, University of Bergen, Bergen, Norway. † University of Science and Technology, Department of Periodontology, Omdurman, Sudan. ‡ Deceased; previously, Department of Oral Sciences–Oral Microbiology, University of Bergen. § Periodontal Diagnostics Research Laboratory, Department of Periodontology and Oral Implantology, Temple University School of Dentistry, Philadelphia, PA. doi: 10.1902/jop.2010.090709 J Periodontol • June 2010 891