Abstract
BACKGROUND: Periodontal disease during adolescence is increasingly recognised as a public health concern due to its high global prevalence and long-term health implications. Despite this, no large-scale studies have assessed its burden among adolescents in Palestine. This study aimed to estimate the prevalence of periodontal diseases among 9th-grade students in the northern West Bank and examine its association with key behavioural and socioeconomic factors. METHODS: A cross-sectional study was conducted among 3,352 15-year-old students, selected through stratified proportional random sampling from governmental and private schools. Periodontal health was assessed using the WHO Community Periodontal Index for Treatment Needs, and oral hygiene status was measured with the Simplified Oral Hygiene Index. Participants also completed a structured questionnaire that assessed their socioeconomic status, oral hygiene practices, dietary habits, and smoking habits. Data were analysed using descriptive statistics, bivariate analysis, and multivariate logistic regression. RESULTS: The prevalence of periodontal diseases was 86.8% among the participating students. Gingival bleeding affected 44.6% of the sample, and calculus was present in 42.2%. Brushing frequency and oral hygiene status were identified as the most significant predictors that greatly increased the risk of periodontal disease, with Adjusted Odds Ratios of 2.05 and 1.6, respectively. Using medium-bristled toothbrushes was a protective factor for the likelihood of having healthy gums (AOR = 1.79). Frequent fish consumption also had a protective association (AOR = 2.04). Conversely, smoking water pipes was negatively associated with periodontal health (AOR = 0.63), indicating a higher risk of disease among users. CONCLUSION: This study revealed a high prevalence of early periodontal disease among 9th-grade students in the northern governorates of the West Bank, with only 13.2% exhibiting healthy gingiva. Several modifiable determinants-such as oral hygiene practices, toothbrush type, dietary habits, and water-pipe smoking-were significantly associated with periodontal health. Addressing these determinants is critical to preventing disease development and reducing its progression in this age group. Therefore, implementing structured, school-based educational programs tailored to these determinants is strongly recommended.