Prevalence and Associated Risk Factors of Gingivitis among Primary School Children (7-11 Years) in Al-Najaf, Iraq: A Cross-sectional Study

Gingivitis represents the most prevalent form of periodontal disease in children worldwide, characterized by reversible gingival inflammation without loss of connective tissue attachment. Despite its preventable nature, gingivitis affects a substantial proportion of school-age children globally, with prevalence rates that vary significantly across different populations and geographic regions. Limited contemporary data exist regarding gingivitis prevalence among Iraqi children, particularly in the post-conflict era in which healthcare systems and oral health promotion programs have faced significant challenges. The purpose of this study was to determine the prevalence of gingivitis and identify associated risk factors among primary school children aged 7–11 years in Al-Najaf city, Iraq.

A cross-sectional study was conducted among 531 children (200 boys and 331 girls) from four randomly selected primary schools in Al-Najaf city between December 2021 and January 2022. Clinical examinations included assessment of gingival inflammation using the Löe and Silness Gingival Index and plaque accumulation using the Silness and Löe Plaque Index. Data on oral hygiene practices, sociodemographic factors, and dental care utilization were collected through structured questionnaires. Statistical analysis involved descriptive statistics, chi-square tests, and multivariate logistic regression to identify associated factors.

The overall prevalence of gingivitis was 16.6% (88/531), with 83.4% of children showing healthy gingiva. Mild gingivitis was observed in 13.0% of participants, moderate gingivitis in 2.8%, and severe gingivitis in 0.8%. Significant associations were found between gingivitis and toothbrushing frequency (p < 0.001), plaque accumulation (p < 0.001), and dental caries experience (p < 0.05). Children who never brushed their teeth had 3.2 times higher odds of developing gingivitis compared to those who brushed twice daily (OR = 3.2, 95% CI: 1.8-5.7). The presence of dental plaque was the strongest predictor of gingivitis (OR = 4.8, 95% CI: 2.9-7.9).

The 16.6% prevalence aligns with global epidemiological data, positioning gingivitis as a significant local health issue. The strong predictive power of plaque presence and lack of toothbrushing confirms that the disease in this cohort is overwhelmingly linked to modifiable hygiene practices. This finding is particularly critical given that over a third of the children reported never brushing, highlighting a substantial gap in basic oral self-care that directly contributes to the observed disease burden. These findings underscore the urgent need for targeted public health interventions, such as school-based oral health programs, to address these modifiable risk factors and improve the oral health of children in this post-conflict region.

The prevalence of gingivitis among schoolchildren in Al-Najaf is consistent with global estimates and shows significant associations with modifiable risk factors. Enhanced oral health education programs and improved access to preventive dental care are essential for reducing the burden of gingival disease in this population.