Volume 77 • Number 6

Relationship Among Gender, Race, Age,

Gingival Width, and Probing Depth in
Primary Teeth
Isaac Suzart Gomes-Filho,* Dario Augusto Oliveira Miranda,* Soraya Castro Trindade,* Carlos
Antônio de Souza Teles Santos,* Camila Oliveira Teixeira de Freitas,* Simone Seixas da Cruz,*
Taı́ze Cássia Nascimento de Macêdo,* and Johelle de Santana Passos*

Background: Limited information is available regarding

the attached keratinized tissue, probing depth, and sociode-
mographic characteristics of primary teeth. This study was
carried out to evaluate the relationship among age, gender,
race, gingival width, and probing depth in each primary tooth
type.

Methods: The study population consisted of 300 children,
aged 4 to 6 years, with clinically healthy gingiva, who were en-
rolled in an oral health program. Gingival width and probing
depth were measured with a standard Williams periodontal
probe in the middle of the keratinized gingiva and at six gin-
gival sites (mesio-buccal, mid-buccal, disto-buccal, mesio-
lingual, mid-lingual, and disto-lingual), respectively. Schiller’s
solution was used to establish the limits of keratinized gingiva.
Results: The gingival width (mean – SD) on the buccal sur-
faces decreased from anterior to posterior positions in both
arches; in the lower lingual surfaces, the inverse was observed.
The gingival width (mean – SD) ranged from 2.95 – 0.15 mm
to 6.16 – 0.20 mm and the probing depth from 1.03 – 0.91 mm
to 2.08 – 0.07 mm. There was a tendency toward increased
probing depth as age increased from 4 to 6 years. There was
also an increase in the probing depth from anterior to posterior
teeth.
Conclusions: In the majority of observations, it was con-
cluded that there was a relationship among age, gingival
width, and probing depth, but generally not among race and
gender and these measurements, respectively. Furthermore,
there is no relation between gender and gingival width and
race and probing depth. J Periodontol 2006;77:1032-1042.
KEY WORDS
Anatomy; gingiva; primary teeth.
* Department of Periodontics, Feira de Santana State University, Bahia, Brazil.
D
ifferent forms of periodontal dis-
ease can present in children,
ranging from reversible condi-
tions limited to the gingival tissue to
those that destroy the connective tissue
attachment and alveolar bone, which
may jeopardize the longevity of the pri-
mary or permanent dentition. Because
there is a much lower prevalence of de-
structive periodontal disease in children
than in adults, diagnosis in children is
more difficult. However, because early
diagnosis is important for successful
treatment, it is imperative that children
receive a periodontal examination as
part of their routine dental visits.
Periodontal probing depth (PD) is an
important diagnostic method to evaluate
the presence and severity of periodontal
disease and to monitor the effectiveness
of treatment. In permanent teeth, a PD
between 0 and 3 mm is considered nor-
mal. In histologic terms, this measure-
ment frequently represents penetration
of the probe through the base of the sul-
cus into the junctional epithelial cells (1 to
1.5 mm apical from the bottom of the his-
tologic sulcus).1 An increase in PD is often
related to the progression or recurrence
of periodontitis. There are several vari-
ables to be considered when measuring
PD: the force applied during probing,
the probe diameter, the probe insertion
angle, anatomical and pathologic fac-
tors, and inflammation of the periodontal
tissues.2-6

doi: 10.1902/jop.2006.050198

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J Periodontol • June 2006 Gomes-Filho, Miranda, Trindade, et al.

Table 1.
Gingival Width on Buccal Surfaces of Maxillary Teeth Using Random Coefficient
Analysis for Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD (mm) Age Gender Race

4 121 4.72 – 0.185

5 189 4.98 – 0.162
Central incisor 6 72 5.38 – 0.192
P = 0.18 0.009 NS NS
Random effect
var(Uoi ) 1.14, var(R ti) 0.59
4 124 4.53 – 0.156
5 223 4.89 – 0.136
Lateral incisor 6 148 5.26 – 0.156
P = 0.0071 0.0002 NS NS
Random effect
var(Uoi) 0.96, var(R ti) 0.53
4 123 3.59 – 0.141
5 235 4.06 – 0.122
Canine 6 191 4.27 – 0.140
P = 0.0036 0.0001 NS NS
Random effect
var(Uoi) 0.87, var(R ti) 0.55

4 122 3.18 – 0.120

5 229 3.49 – 0.104
First molar 6 171 3.89 – 0.120
P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.7, var(R ti) 0.57

4 121 3.74 – 0.140

5 229 4.09 – 0.121
Second molar 6 178 4.43 – 0.137
P = 0.0012 0.0001 NS NS
Random effect
var(Uoi) 0.86, var(R ti) 0.48
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.

Although periodontal PD is an important clinical
tool for diagnosing periodontal disease and evaluating
therapy, this procedure has limitations because it
does not detect current disease activity but merely
demonstrates the past destruction pattern. The nor-
mal PDs in primary teeth have not been clearly
defined, and there are only a few studies in this
area.7-17
The evaluation of gingival width in primary teeth
has not been thoroughly investigated. The impor-
tance of attached keratinized tissue around natural
teeth is a controversial topic18-20 since, historically,
an adequate band of keratinized tissue was viewed
as important to prevent future recession.20 According
to the 1996 Consensus Report on Mucogingival Ther-
apy,21 indications still exist for increasing the width of
keratinized tissue because of its importance in main-
taining periodontal health. However, it has been sug-
gested that keratinized tissue may not be needed in
many situations.22
Most of the research addressing gingival width in
primary teeth was done in children in their own coun-
tries of residence.7-9,14,17,23-25 Research involving
different nationalities may identify ethnic differences
not found in previous studies. It should also be noted
that a country’s population can include a number of
ethnic groups, each of which may possess unique
genetic characteristics.

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Gingival Width and Probing Depth in Primary Teeth Volume 77 • Number 6

Table 2.
Gingival Width on Buccal Surfaces of Mandibular Teeth Using Random Coefficient
Analysis for Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD (mm) Age Gender Race

4 117 5.07 – 0.129

5 219 5.11 – 0.104
Central incisor 6 140 5.43 – 0.119
P = 0.0115 0.011 NS NS
Random effect
var(Uoi) 0.72, var(R ti) 0.37
4 119 4.78 – 0.109
5 230 4.85 – 0.929
Lateral incisor 6 176 5.17 – 0.104
P = 0.037 0.001 NS NS
Random effect
var(Uoi) 0.59, var(R ti) 0.54
4 123 3.38 – 0.109
5 237 4.04 – 0.090
Canine 6 191 4.18 – 0.092
P = 0.053 0.016 NS NS
Random effect
var(Uoi) 0.58, var(R ti) 0.53

4 125 3.35 – 0.086

5 233 3.49 – 0.075
First molar 6 184 3.81 – 0.086
P = 0.000 0.000 NS 0.04
Random effect
var(Uoi) 0.42, var(R ti) 0.53

4 122 3.94 – 0.103

5 232 4.08 – 0.088
Second molar 6 187 4.35 – 0.101
P = 0.0009 0.001 NS NS
Random effect
var(Uoi) 0.60, var(R ti) 0.44
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.

In the 1980s, it was believed that the integrity of pri-
mary teeth and their structures could influence the
stability of occlusion and the health of the permanent
dentition.6 Among the many aspects evaluated, the
gingival width may play an important role in the ho-
meostasis of the periodontium by resisting traumatic
damage to the gingiva. The rationale for evaluating
adequate gingival width included facilitating plaque
control and improving patient comfort in conjunction
with restorative or prosthetic dentistry. There are a num-
ber of factors that influence gingival width, including
tooth location, age, and genetics. The objective of this
research was to evaluate the relationship among age
(4, 5, and 6 years), gender (boys and girls), race
(white, clear mulatto, medium mulatto, dark mulatto,
and black26,27), and mean (– SD) values of gingival
width and PD in each primary tooth type.
MATERIALS AND METHODS
A total of 300 children (153 boys and 147 girls), rang-
ing in age from 4 to 6 years, from Dagmar Silva
School, Feira de Santana, Bahia, Brazil, participated
in this cross-sectional study. All of the children were
in an oral health program that included weekly oral
hygiene motivation and application of 1.23% fluoride
using a toothbrush. Clinical visits included scaling,
restorations, and extractions as needed.

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J Periodontol • June 2006 Gomes-Filho, Miranda, Trindade, et al.

Table 3.
Gingival Width on Lingual Surfaces of Mandibular Teeth Using Random Coefficient
Analysis for Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD (mm) Age Gender Race

4 121 2.95 – 0.154

5 189 3.38 – 0.142
Central incisor 6 72 3.74 – 0.190
P = 0.0055 0.0004 NS NS
Random effect
var(Uoi) 0.96, var(R ti) 0.26
4 124 3.13 – 0.147
5 223 3.76 – 0.131
Lateral incisor 6 148 4.20 – 0.151
P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.89, var(R ti) 0.52
4 123 4.05 – 0.152
5 235 4.56 – 0.132
Canine 6 191 4.87 – 0.149
P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.93, var(R ti) 0.56

4 122 4.85 – 0.175

5 229 5.26 – 0.155
First molar 6 171 5.49 – 0.177
P = 0.0226 0.007 NS NS
Random effect
var(Uoi) 1.07, var(R ti) 0.67

4 121 5.66 – 0.199

5 229 6.02 – 0.177
Second molar 6 178 6.16 – 0.199
P = 0.1999 NS NS NS
Random effect
var(Uoi) 1.26, var(R ti) 0.63
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.

The research project was approved by the Ethics PD Measurements

Research Committee of São Rafael Hospital, in
Salvador, Bahia, Brazil. Informed consent forms were
signed by parents or adults who were responsible for
the children.
Gingival Width Measurements
The mucogingival junction was identified by stain-
ing with Schiller’s solution (an iodine-based sub-
stance) to establish the limits of keratinized gingiva.
Gingival width was measured in the middle area on
each tooth from the gingival margin to the mucogin-
gival junction using a standardized periodontal probe.
All measurements were rounded to the nearest milli-
meter.
PD was measured by a single calibrated examiner
using a standardized Williams periodontal probe at
six sites: mesio-buccal, mid-buccal, disto-buccal,
mesio-lingual, mid-lingual, and disto-lingual. All mea-
surements were rounded to the nearest millimeter.
Intraexaminer Reliability
The examiner in the study was selected because of
significant previous experience. The intraexaminer cal-
ibration was performed before the study began. Reli-
ability was determined by having the examiner make
dual measurements, along with those of the project
director (ISGF), in at least two patients and to indicate
any measurement differences >1 mm. Reliability was

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Gingival Width and Probing Depth in Primary Teeth Volume 77 • Number 6

Table 4.
Probing Depth on Buccal Sites of Primary Teeth Using Random Coefficient Analysis for
Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD Age Gender Race

4 112 1.26 – 0.098

5 221 1.44 – 0.087
Central incisor 6 140 1.55 – 0.089
(maxilla) P = 0.018 0.039 NS NS
Random effect
var(Uoi) 0.50, var(R ti) 0.29
4 115 1.09 – 0.072
5 232 1.18 – 0.063
Lateral incisor 6 177 1.27 – 0.064
(maxilla) P = 0.0021 0.034 0.030 NS
Random effect
var(Uoi) 0.31, var(R ti) 0.36
4 120 1.27 – 0.075
5 238 1.28 – 0.066
Canine 6 193 1.37 – 0.065
(maxilla) P = 0.0021 NS NS NS
Random effect
var(Uoi) 0.31, var(R ti) 0.36
4 122 1.17 – 0.072
5 235 1.22 – 0.063
First molar 6 186 1.29 – 0.064
(maxilla) P = 0.07 NS NS NS
Random effect
var(Uoi) 0.31, var(R ti) 0.39
4 119 1.80 – 0.071
5 234 1.85 – 0.062
Second molar 6 189 1.76 – 0.061
(maxilla) P = 0.06 NS NS NS
Random effect
var(Uoi) 0.32, var(R ti) 0.36
4 115 1.04 – 0.087
5 188 1.14 – 0.082
Central incisor 6 72 1.54 – 0.097
(mandible) P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.42, var(R ti) 0.26

4 119 1.11 – 0.710

5 224 1.11 – 0.063
Lateral incisor 6 149 1.39 – 0.066
(mandible) P = 0.000 0.000 NS NS
Random effect
var(Uoi) 0.35, var(R ti) 0.28
4 117 1.11 – 0.063
5 236 1.13 – 0.555
Canine 6 193 1.27 – 0.055
(mandible) P = 0.015 0.007 NS NS
Random effect
var(Uoi) 0.28, var(R ti) 0.33

1036
J Periodontol • June 2006
Table 4. (continued)
Probing Depth on Buccal Sites of Primary Teeth Using Random Coefficient Analysis for
Ages 4, 5, and 6 Years, Adjusted by Gender and Race
Tooth Age (years) N Teeth
4 117
5 230
First molar 6 173
(mandible) P = 0.01
Random effect
var(Uoi) 0.22, var(R ti) 0.39
4 116
5 228
Second molar 6 178
(mandible) P = 0.17
Random effect
var(Uoi) 0.32, var(R ti) 0.44
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.
confirmed by taking repeated measurements at the
same site during the calibration sessions and in ;10%
of the patients (randomly selected) during the study.
The intraexaminer degree of agreement (k = 0.845 and
0.819) was classified as very good for PD and gingival
width, respectively, according with the classification
proposed by Altman.28 Furthermore, the reproduc-
ibility, expressed as a proportion of interexaminer
agreement, was 92% for PD and 89% for gingival width.
Race Identification
Race was determined using criteria established by
Krieger et al.26 and Azevêdo27 (i.e., skin color, hair tex-
ture, head structure, and lip configuration). Skin color
was classified as white, clear mulatto, medium mu-
latto, dark mulatto, or black. The clear, medium, and
dark mulatto classifications were lumped together in
a single category of mulatto to simplify the statistical
analysis.
Statistical Analysis
The recorded data were tabulated for statistical anal-
ysis. Gingival width and PD measurements were ana-
lyzed using a statistical program.† The Student t test
was used to evaluate the statistical significance of
differences in mean values in symmetrical primary
teeth.29 The means of the three buccal PD measure-
ments were determined, as well as those of the three
lingual measurements.
Random coefficient analysis was used to evaluate
the effect of age, gender, and race on gingival width
and PD29,30 using another statistical program.‡
The basic idea behind the use of random coefficient
analysis is that the regression coefficient is allowed to
Gomes-Filho, Miranda, Trindade, et al.
Model Terms
Mean – SD Age Gender Race
1.06 – 0.061
1.04 – 0.055
1.21 – 0.054
0.003 0.047 NS
1.48 – 0.080
1.58 – 0.071
1.50 – 0.070
NS 0.035 NS
differ between subjects (children), i.e., heterogeneity
across individuals is allowed. The simplest form of ran-
dom coefficient model is a model with just a random
intercept, where essential assumptions are that all re-
siduals, Uoj, a random effect at the group (children)
level, and Rij, a random effect at the individual (tooth)
level, are mutually independent and have zero means
given values xij of the exploratory analysis. The ran-
dom variable Uoj and Rij have variances var(Rij) and
var(Uoj). The fraction of residual variability that can
be ascribed for group level is the intraclass correlation
coefficient. This parameter is the correlation between
the Y value of two randomly drawn individuals in one
randomly drawn group, controlling for variable X. The
covariance model used was as follows: Yij = boj + b1age
+ b2race + b3gender + Uoj + Rij, where Yij is the gingival
width or PD response for children j, j = 1,2. . ., n at the ith
tooth, and i = 1,2; boj is the highest average of the de-
pendent variable (gingival width or PD); b1, b2, and b3
are the fixed coefficients for the covariables age, race,
and gender; age is the covariable dummy; race is the
covariable dummy; gender is the dichotomous cova-
riable; Uoj is the random effect at the children level;
and Rij is the random effect at the tooth level.
RESULTS
Table 1 shows gingival width measurements on buc-
cal surfaces of the maxillary teeth using random coef-
ficient analysis for ages 4, 5, and 6 years, adjusted by
gender and race. There was an increase in the gingival
† Excel 2000, Microsoft, Seattle, WA.
‡ STATA v.9.0, College Station, TX.
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Gingival Width and Probing Depth in Primary Teeth Volume 77 • Number 6

Table 5.
Probing Depth on Lingual Sites of Primary Teeth Using Random Coefficient Analysis for
Ages 4, 5, and 6 Years, Adjusted by Gender and Race

Model Terms

Tooth Age (years) N Teeth Mean – SD (mm) Age Gender Race

4 112 1.49 – 0.930

5 221 1.65 – 0.0082
Central incisor 6 140 1.71 – 0.0850
(maxilla) P = 0.11 0.05 0.03 NS
Random effect
var(Uoi) 0.47, var(R ti) 0.31
4 115 1.38 – 0.080
5 232 1.55 – 0.070
Lateral incisor 6 177 1.62 – 0.070
(maxilla) P = 0.0031 0.006 0.04 NS
Random effect
var(Uoi) 0.37, var(R ti) 0.38
4 120 1.29 – 0.072
5 238 1.47 – 0.063
Canine 6 193 1.55 – 0.063
(maxilla) P = 0.000 0.001 0.0002 NS
Random effect
var(Uoi) 0.21, var(R ti) 0.50
4 122 1.44 – 0.083
5 235 1.56 – 0.073
6 186 1.63 – 0.073
First molar P = 0.15 NS NS NS
(maxilla) Random effect
var(Uoi) 0.40, var(R ti) 0.39
4 119 1.65 – 0.075
5 234 1.77 – 0.066
6 189 1.77 – 0.065
Second molar P = 0.009 NS 0.003 NS
(maxilla) Random effect
var(Uoi) 0.34, var(R ti) 0.36
4 115 1.03 – 0.910
5 188 1.23 – 0.085
Central incisor 6 72 1.56 – 0.100
(mandible) P = 0.000 0.000 0.015 NS
Random effect
var(Uoi) 0.43, var(R ti) 0.27
4 119 1.11 – 0.077
5 224 1.28 – 0.069
Lateral incisor 6 149 1.47 – 0.071
(mandible) P = 0.000 0.000 0.032 NS
Random effect
var(Uoi) 0.37, var(R ti) 0.33
4 117 1.14 – 0.075
5 236 1.27 – 0.065
Canine 6 193 1.49 – 0.064
(mandible) P = 0.000 0.000 0.0038 NS
Random effect
var(Uoi) 0.34, var(R ti) 0.35

1038
J Periodontol • June 2006
Table 5. (continued)
Probing Depth on Lingual Sites of Primary Teeth Using Random Coefficient Analysis for
Ages 4, 5, and 6 Years, Adjusted by Gender and Race
Tooth Age (years) N Teeth
4 117
5 230
First molar 6 173
(mandible) P = 0.064
Random effect
var(Uoi) 0.32, var(R ti) 0.39
4 116
5 228
Second molar 6 178
(mandible) P = 0.425
Random effect
var(Uoi) 0.36, var(R ti) 0.38
var(Uoi) = random variable Uoj variance; var(Rti) = random variable Rij variance; NS = not statistically significant.
width based on age from 4 to 6 years. For example, the
lateral incisor gingival width (mean – SD) at 4 years
old was 4.53 – 0.16 mm; at 5 years old, 4.89 – 0.14
mm; and at 6 years old, 5.26 – 0.16 mm. The global
Wald test and P values illustrate a linear model among
the study variables, with statistically significant results
(P £0.05), except for the central incisor. In agreement
with the model terms, the age variable showed statis-
tical significance in teeth that demonstrated the exis-
tence of the linear model. The other terms of the model
(gender and race) did not demonstrate any statistical
significance. Gingival width (mean – SD) ranged from
3.18 – 0.12 mm to 5.38 – 0.19 mm.
Table 2 shows gingival width measurements on
buccal surfaces of the mandibular teeth using random
coefficient analysis for ages 4, 5, and 6 years, adjusted
by gender and race. The global Wald test and P val-
ues illustrate a linear model among the study vari-
ables, with statistically significant results (P £0.05).
In agreement with the model terms, the age variable
showed statistical significance in all teeth, whereas
race showed a statistically significant difference for
the first molar only. An increase in the gingival width
mean based on an increase of age from 4 to 6 years
was also observed. Gingival width (mean – SD) ranged
from 3.35 – 0.09 mm to 5.43 – 0.12 mm.
Gingival width measurements for lingual surfaces
of the mandibular teeth are shown in Table 3, using
random coefficient analysis for ages 4, 5, and 6 years
adjusted by gender and race. In the majority of teeth,
there was an increase in the gingival width (mean – SD)
as age increased from 4 to 6 years, except for second
Gomes-Filho, Miranda, Trindade, et al.
Model Terms
Mean – SD (mm) Age Gender Race
1.72 – 0.074
1.82 – 0.066
1.86 – 0.065
NS NS NS
1.93 – 0.079
2.08 – 0.070
2.03 – 0.069
NS NS NS
molars. The global Wald test and P values illustrate the
existence of a linear model among the study variables
with statistically significant results (P £0.05), except
for second molars. In agreement with the model terms
of analysis, the age variable showed statistical signifi-
cance in teeth that demonstrated the existence of the
linear model. Gingival width (mean – SD) ranged from
2.95 – 0.15 mm to 6.16 – 0.20 mm.
Tables 4 and 5 show mean values of PD on buccal
and lingual sites, respectively, of primary teeth using
the random coefficient analysis for ages 4, 5, and 6
years, adjusted by gender and race. In the majority
of teeth, there was an increase in the PD (mean –
SD) as age increased from 4 to 6 years. For example,
in Table 4, the upper central incisor on the buccal
side (mean – SD) at 4 years old was 1.26 – 0.10
mm; at 5 years, 1.44 – 0.09 mm; and at 6 years,
1.55 – 0.09 mm. This tendency toward deeper PDs
as age increased was also observed in the other teeth.
In addition, the global Wald test and P values in the
buccal sites showed the existence of a linear model
among the study variables in the majority of teeth with
statistically significant results (P £0.05). In agreement
with the model terms, the age variable showed statis-
tical significance in the majority of teeth and was re-
sponsible for the existence of the linear model.
However, gender and race models did not demon-
strate statistical significance in the majority of teeth.
PD (mean – SD) ranged from 1.04 – 0.09 mm to
1.65 – 0.06 mm.
Table 5 shows PD measurements at the lingual sites
of teeth. The global Wald test and P values showed the
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Gingival Width and Probing Depth in Primary Teeth
existence of a linear model among the study variables
in all the teeth with statistically significant results
(P £0.05), except for the upper central incisor and first
molar and lower first and second molars. In agreement
with the model terms, the age variable showed statis-
tical significance for the majority of teeth, except the
lower second molars. The gender variable showed
statistical significance in 70% of teeth. However, the
model term of race did not demonstrate statistical sig-
nificance. PD (mean – SD) ranged from 1.03 – 0.91
mm to 2.08 – 0.07 mm.
DISCUSSION
The existence of periodontal diseases in children, both
gingivitis and periodontitis, is well documented and
established.31-37 An experimental gingivitis study
comparing six children (aged 4 to 5 years) with six
dental students (age 23 to 29 years) showed that
the children developed gingivitis less readily than
the adults. Children developed significantly less bleed-
ing units (8.6% versus 43.9%) at day 21 in teeth with
the same plaque index.31 Plaque-induced gingivitis is
prevalent in children and adolescents.32,33 Typical
features of this form of gingivitis include gingival red-
ness, swelling, loss of contour, marginal bleeding, and
pseudopockets in the absence of bone loss, all of
which are reversible following appropriate therapy.
Page et al.34 first described prepubertal periodontitis
as a distinct clinical entity, defining it as usually occur-
ring during or soon after the eruption of the primary
teeth. Both familial clustering of prepubertal peri-
odontitis and a higher incidence in girls have been
documented.34-37 Watanabe38 reviewed diagnostic
criteria, pathogenesis, and differential diagnosis of pre-
pubertal periodontitis, concluding that there is no asso-
ciation with systemic conditions (i.e., neutropenia)
and the prevalence ranging from 0.84% to 26.9%.
An important variable considered in this study was
the gingival condition of the tooth. The children who
participated were in an oral health program for 3 years,
which included weekly motivation, fluoride applica-
tion, and clinical visits with scaling, restorations, and
extractions. Based on the low bleeding on probing
score39 (4.41% of sites), general gingival conditions
were very healthy. The data also showed that all teeth
except the lower central incisors had similar values in
7,351 gingival width sites (Tables 1 through 3) and in
30,528 PD sites (Tables 4 and 5) of all age groups
and both genders. The lower central incisors pre-
sented with lower number evaluations in children at
6 years old, with 70 and 64 evaluated teeth/surfaces
(Tables 3 and 4, respectively). This pattern is consistent
with the loss of primary dentition, which begins
around 6 years with the lower central incisors.
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Volume 77 • Number 6
Many investigations, including this one, present the
gingival width and PD according to maxillary or man-
dibular tooth type.7-17,25 In the present study, the
Student t test used to evaluate the median values in
the symmetrical primary teeth did not show statistical
significance among the measurements for most of
the analyses.
To the best of our knowledge, this is the first study to
investigate both gingival width and PD in primary teeth
in conjunction with the variables of age, gender, and
race. Furthermore, the statistical analysis used (the
random coefficient analysis) allowed the heterogene-
ity across children to differ, established the associa-
tion between the dependent and independent study
variables, and confirmed the relationship among the
age, gender, race, and two clinical parameters.
Gingival Width
The gingival width of 7,351 surfaces in 4,958 teeth
from 300 children in this study agrees with earlier
data. Most earlier studies7,9,14,17,40,41 confirm that
gingival width on buccal surfaces of both arches de-
creases from anterior to posterior positions. In the pres-
ent study, gingival width was highest on maxillary
upper central incisors and lowest on maxillary first
molars (Table 1). Gingival width on mandibular lin-
gual surfaces increased from anterior to posterior po-
sitions (highest value: second molars; lowest values:
central incisors; Table 3).
An increase in gingival width measurement on buc-
cal surfaces of both arches was observed as age in-
creased from 4 to 6 years. The age variable was the
model term responsible for the linear model in evalu-
atedteeth(Tables1and2).However,therace(P £0.05)
variable was also responsible for the linear model in
the lower first molar. Other studies7,9,14,17,24,25 confirm
that the general increase in gingival width is correlated
with an increase in age.
An increase in gingival width on lingual surfaces
of mandibular primary teeth was observed as age in-
creased from 4 to 6 years. Once more, the age variable
was the model term responsible for the linear model in
all teeth. Consequently, in agreement with the results of
the present study (Tables 1 through 3) and those of
previously published studies,7,9,14,17,24,25 the age var-
iable has a significant influence on the gingival width
of lingual and buccal surfaces. A specific evaluation
of the gingival width on the lingual surfaces of pri-
mary teeth was reported only by the Gomes-Filho
et al. studies.40,41
The data from this study were obtained from a pop-
ulation representing a group of Brazilian children with
specific ethnic features.26,27 The mean gingival width
values on the lingual and buccal surfaces ranged from
2.95 – 0.15 mm to 6.16 – 0.20 mm. The standard
deviation values presented in this study showed an
J Periodontol • June 2006
interindividual variation. It is suggested that further in-
vestigation should be done to compare the gingival
width in primary teeth with permanent ones.
Probing Depth
The mean gingival PD values of 30,528 sites of 5,088
teeth of 300 children evaluated in this study agree
with earlier studies.10-16 In the majority of buccal
and lingual sites measured in the present study, mean
values increased from anterior to posterior positions
in both arches. The mean PD values for all teeth exam-
ined showed the highest mean value in lingual sites of
mandibular second molars (2.08 – 0.07 mm) and
the lowest mean in lingual sites of mandibular central
incisors (1.03 – 0.91 mm).
In the majority of teeth, an increase in PD was ob-
served as age increased from 4 to 6 years. In agree-
ment with the results of the present study (Tables 4
and 5) and with those previously reported,7-16 age
has a significant influence on the PDs at both lingual
and buccal sites, except for maxillary and mandibular
second molars. This is most likely due to the eruption
of the permanent first molar distal to this area and
the remodeling of the ramus and tuberosity in a grow-
ing child that provides space for second and third
molars.42,43
Only one other report11 was found that used the
same ethnic group as the present study. However, it
is not known whether genetic factors are important
in determining PDs. The PDs in the present study
ranged from 1.03 – 0.91 mm (central incisor, lingual
sites) to 2.08 – 0.07 mm (second molars, lingual
sites). The standard deviation values presented here
showed interindividual variation. Because the deepest
PD (2.08 mm) in this study was found in mandibular
second molars, it may be that clinicians have under-
estimated periodontal conditions in primary teeth.
Based on these data, it is suggested that a further
investigation to compare the PD in primary teeth to
permanent teeth would be of value.
Within the limitations of this research, it may be
suggested that: 1) the mean values of gingival width
on the buccal surfaces decrease from anterior to pos-
terior positions in both arches; however, in the man-
dibular lingual surfaces, the inverse was observed;
2) the mean PD values increase from the anterior to
posterior primary teeth in both arches; 3) there is a re-
lationship between age (4 to 6 years) and an increase
in the gingival width in the majority of the observa-
tions, but, generally, this relationship was not ob-
served with the covariable race; furthermore, there is
no relation between gender and this measurement in
the studied population; and 4) there is a relationship
between age (4 to 6 years) and an increase in PD in
the majority of the observations, but, generally, this
relationship was not observed with the covariable
Gomes-Filho, Miranda, Trindade, et al.
gender; furthermore, there is no relation between race
and this measurement in the studied population.
ACKNOWLEDGMENTS
The authors thank Dr. Neil Blumenthal, University of
Illinois at Chicago, Chicago, Illinois, for help during
the preparation of this manuscript and Drs. Eliane
Azevêdo and Eneida Moraes Marcı́lio Cerqueira, Feira
de Santana State University, for assisting with gather-
ing data and making the development of this research
possible.
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Correspondence: Dr. Isaac Suzart Gomes-Filho, Av.
Getúlio Vargas, 379 Centro, Feira de Santana, Bahia, Brazil
44025-010. Fax: 55-75-3623-0661; e-mail: i-suzart@uol.
com.br; isuzart@gmail.com.
Accepted for publication January 10, 2006.