Periodontal disease is a spectrum of health anomalies affecting the surrounding structures of the teeth including the gums, periodontal ligament and alveolar bone (Chauhan et al 2012). These anomalies may be restricted to the gingiva (gingivitis) or may extend to the periodontal ligament space and alveolar bone (periodontitis). Periodontitis may lead to tooth mobility, pathologic migration and eventual loss of teeth(Folayan et al. 2014). The clinical signs of periodontal disease may appear at any age and epidemiological studies indicate that gingivitis, which varies in severity, is almost a universal finding in children and adolescents, while destructive periodontitis is of lower prevalence in younger individuals when compared with adults(Chauhan et al 2012) . A Nigerian study has reported a relatively high occurrence of deep pockets in young Nigerians(Akpata 2014). However, whether these pockets are true (pockets greater than 6 mm deep) or false pockets (less than or equal to 6 mm) was not specified. The first step in proper planning for oral health among young children is to establish the prevalent oral health problem, which in this case is the periodontal health condition. This will help to promote evidence-based intervention programs(Folayan et al. 2014) .According to Sane, Nikhbakht-Nasrabadi(2005) The Community Periodontal Index for Treatment Needs is thus a valuable tool in assessment for health policy making and strategic planning for oral health implementation programs and this is true even among childrenEpidemiological trends have shown waxing and waning in both oral cleanliness and occurrence of gingivitis in children and adolescents. Deterioration appears to be more evident when the age range of subjects studied is wide(Hatem 2012). An earlier Nigerian study in Ile-Ife reported a prevalence of periodontal diseases of 84.2% among 3-20-year olds(Akpata 2004) , while a more recent study in Benin City revealed a prevalence rate of 99.2% among 5-19-year old(Odai et al 2009) . Both studies reported a high occurrence of gingivitis and heavy deposits of calculus but little evidence of damage to the periodontal tissues. However, these studies used the gingival index of Loe and Silness, plaque index of Silness and Loe and the oral hygiene index of Greene and Vermilion in their assessment. In a study among institutionalized mentally handicapped Nigerian children using the CPITN, a high level of gingivitis and periodontal diseases was reported, with 92.9% of assessed sextants involved in periodontal tissue changes. A similar finding was reported in a similar population of Iranian children(Nematollahi et al  2010) . A study comparing public and private school children found that presence of calculus and gingivitis was less in private school children (Adenubi 1984). This suggests that oral hygiene was better when socio-economic status was high, as it has been previously reported(Khan  et al 2011). Another study has reported that only 17.8% of 11-14 years old Nigerian children had good oral hygiene, while about 50.4% had fair oral hygiene(Nematollahi et al  2010). This study corroborated the gender difference in oral cleanliness reported by previous studies(Adenubi 1984), with female children exhibiting better hygiene status than males. It has also been reported that severity of gingivitis lessens as age increases

Periodontal disease is highly prevalent, contributing to the global burden of chronic diseases and constituting a major public health problem (Petersen and Baehni, 2012; Petersen and Ogawa, 2012). The importance of oral health, of which periodontal health is a key component, to general well-being has been well documented (USDHHS, 2000). Most periodontal diseases are inflammatory in nature and are initiated by plaque biofilm, resulting in gingivitis. When untreated, this mild form of the disease may progress to periodontitis and tooth loss (Petersen and Ogawa, 2012). The earliest sign of gingivitis is bleeding from the gingiva, especially during tooth brushing. Periodontal disease can be readily reversed by effective plaque control measures, such as daily tooth brushing and the use of interdental cleaning aids (e.g., dental floss) (Darby and Walsh, 2010). Bilateral associations between periodontitis and a wide range of systemic conditions, such as cardiovascular disease (Demmer and Desvarieux, 2006), diabetes mellitus (Mealey, 2006), and poor pregnancy outcomes (Scannapieco et al., 2003), have been reported. Periodontitis may be a source of systemic inflammation that impacts overall health (Quijano et al., 2010). The successful prevention and management of periodontal disease depend to a large extent on awareness and good knowledge of its causes, early identification of symptoms, and effective treatment (Zhu et al., 2005). In Nigeria, the level of awareness of oral diseases in the general population has been documented as being low (Sofola, 2010). This situation may have serious consequences for patients with medical problems and oral issues, such as periodontal disease. Given the grossly inadequate dentist-topopulation ratio in Nigeria (Sofola, 2010), patients are more likely to seek oral health care from medical professionals than from dentists. Similar situations have been documented in other countries (Cohen and Manski, 2006; Cohen et al., 2008). Hence, medical doctors, especially physicians, must be well informed about periodontal disease and its bilateral associations with systemic conditions to ensure best practices in patient care. Previous studies have shown varying levels of awareness among doctors (Weidlich et al., 2008; Gur and Majra, 2011; Nagarakanti et al., 2013; Nasir et al., 2013), with limited awareness in developing countries like Nigeria (Gur and Majra, 2011; Nasir et al., 2013). A few studies have shown reduced awareness and poor referral practices among physicians in Nigeria (Sofola and Ayankogbe, 2009; Opeodu et al., 2014). The aim of this study was to assess the knowledge of periodontal disease, its associations with systemic conditions, and professional attitudes toward periodontal health among internal medicine residents from health institutions across Nigeria.

1.2 STATEMENT OF THE PROBLEM

‘Periodontitis is the most common chronic inflammatory disease seen in humans, affecting nearly half of adults in the Nigeria and 60% of those over 65 years(Demmer and Desvarieux 2006). It is a major public health problem, causing tooth loss, disability, masticatory dysfunction, and poor nutritional status. Periodontitis also compromises speech, reduces quality of life, and is an escalating burden to the healthcare economy

In summary, periodontal disease using a disease definition is highly prevalent, has considerable impacts on individuals and society and is costly to treat; the cost of dental care is the fourth highest costs of all diseases and consuming between 5 and 10% of all healthcare resources.  In Nigeria today as a result of poor health care services, lack of knowledge on the causes of periodontal diseases, poor personal hygiene among others has worsened the situation of the illness among adults. Therefore this study stands in filling the gap on analyzing and reviewing of the causes and effective management of periodontal diseases among adult

1.3      OBJECTIVES OF THE STUDY

The major aim of the study is to examine analyzing and reviewing of the causes and effective management of periodontal diseases among adult. Other specific objectives of the study include;

1) To assess the level of prevalence of periodontal diseases among adults

2) To examine the effect of periodontal diseases on the quality of life of adults in Nigeria

3) To outline the risk factors and causes of periodontal diseases

4) To recommend ways of effective management, prevention and treatment of periodontal diseases among adults

1.4 RESEARCH QUESTIONS

1) What is the level of prevalence of periodontal diseases among adults?

2) What is the effect of periodontal diseases on the quality of life of adults in Nigeria?

3) What are the risk factors and causes of periodontal diseases?

4) What are the ways of effective management, prevention and treatment of periodontal diseases among adults?

1.5 RESEARCH HYPOTHESIS

Hypothesis

H0: There is no significant effect of periodontal diseases on the quality of life of adults.

H1: There is a significant effect of periodontal diseases on the quality of life of adults

1.6 SIGNIFICANCE OF THE STUDY

The study will be of profound benefits to provide information about periodontal diseases especially to adults in Nigeria. It is also expected that the results of this study would produce relevant material for scholarly discourse in dental sciences. This study would also be of immense benefit to students and scholars who are interested in developing further studies on the subject matter

1.7 SCOPE AND LIMITATION OF THE STUDY

The study is restricted to analyzing and reviewing of the causes and effective management of periodontal diseases among adult

1.8 LIMITATION OF THE STUDY

Financial constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview)

Time constraint: The researcher will simultaneously engage in this study with other academic work. This consequently will cut down on the time devoted for the research work.

1.9 OPERATIONAL DEFINITION OF TERMS