Epidemiology of periodontal status in dentate adults in France, 2002-2003

BACKGROUND AND OBJECTIVE: Few recent nationwide studies of the periodontal landscape in European countries have been developed from the point of view of attachment loss and pocket depth. Decision makers are not always in a position to estimate the burden of periodontal disease. The purpose of this study was to investigate the prevalence and the oral distribution of periodontal status among dentate adults in the general population of France. MATERIAL AND METHODS: In 2002-2003, a National Periodontal and Systemic Examination Survey was organized to a stratified quota sample of 2144 adults, aged 35-64 years, nationwide. Participants with six or more teeth were selected from the Health Examination Centers of the National Health Insurance. Measurement of periodontal health was assessed by clinical attachment level and probing depth. RESULTS: A total of 95.40% and 82.23% of adults were found to have clinical attachment loss and periodontal pockets, respectively. Population prevalence estimates indicated that loss of attachment > or = 5 mm is 46.68% and probing depth (> 5 mm) is 10.21%. However, clinical attachment loss of > or = 5 mm occurred in only 0.88 sites in an individual. Periodontal depth pocket generalized forms were as follows: 78% slight, 18% moderate and 4% severe. Multiple logistic regression analyses showed significant differences of attachment loss values between types of tooth (molar, incisors, canines, or premolars). CONCLUSION: Based on the International Classification of Periodontal Diseases, approximately 50% of adults in France may suffer from a severe attachment loss problem. Periodontal pockets are an uncommon condition in France. Significant differences in the prevalence of loss of attachment and probing depth with respect to location of attack have implications in the purchase and development of screening and treatment services.     

Left-to-right distribution of periodontal disease

To cite this article:
Int J Dent Hygiene 10 , 2012; 74–79
DOI: 10.1111/j.1601‐5037.2011.00509.x
Darby IB, Polster A, Gan JS, Guo Q, Henein N, Heredia A, Horina H, Sanduja D, Radvar M. Left‐to‐right distribution of periodontal disease. Abstract: Aim: Symmetry is a property established in many human biological systems and it is reasonable to expect that it may also exist in the mouth. The objective of this study was to examine whether there is a similar left‐to‐right distribution in periodontal disease. Method: Records of 197 patients from the Periodontics department of The Royal Dental Hospital of Melbourne were analysed. The clinical parameters recorded were pocket probing depth, recession, bleeding on probing, mobility and furcation involvement. Results: The average age of our sample group was 47.5 years old, with 34.5% men and 65.5% women. The results demonstrated significant left‐to‐right distribution with all the periodontal indices recorded. Conclusion: The findings support previous studies that show that a similar left‐to‐right distribution exists in the population studied.     

A clinical survey of periodontal conditions in Greece

Abstract The present study used full-mouth clinical assessments of plaque, calculus, bleeding on probing, probing pocket depth and probing attachment level to evaluate the periodontal conditions in a rural (A) and an urban (B) sample of 25–64 year old Greek adults, comprising 190 and 373 subjects, respectively. 13% of the subjects in sample (A) and 8% in sample (B) were edentulous, while mean values of teeth present in the four age cohorts ranged between 19.8—12.6 and 23.3—18.3. respectively. A poor level of oral hygiene was recorded in both samples with high plaque, calculus and bleeding scores. Deep pocketing was more pronounced in the rural than in the urban sample: between 1.7 and 8.0% of all sites probed showed a PPD of ≥6 mm and between 20 and 51.2% of the subjects in each age cohort had at least one deep pocket. Corresponding figures for the urban sample was 0.6-4.7% and 15.1-49.2%. However, the prevalence of severe attachment loss was of comparable magnitude in both samples: between 2.8–25.7% of the sites in sample (A) and 2.8–20.6% in sample (B) displayed a PAL of ≥6 mm, while 32.5-72.1% and 31.8-73.8% of the subjects, respectively, had at least one severely affected site. It was further found that the distribution of advanced disease in the samples was skewed; 14.4% of the subjects in sample (A) and 9.5% in sample (B) accounted for 75%, of all deep pockets, while 21.8 and 19.4% of the subjects, respectively, accounted for 75% of all sites with PAL of ≥6 mm. Multiple regression revealed that male sex and high plaque and bleeding scores had a significant, positive influence to the amount of attachment loss on a subject level.     

Dental nomograms for benchmarking based on the study of health in Pomerania data set

AIM: Benchmarking is a means of setting goals or targets. On an oral health level, it denotes retaining more teeth and/or improving the quality of life. The goal of this pilot investigation was to assess whether the data generated by a population-based study (SHIP 0) can be used as a benchmark data set to characterize different practice profiles. MATERIAL AND METHODS: The data collected in the population-based study SHIP (n=4310) in eastern Germany were used to generate nomograms of tooth loss, attachment loss, and probing depth. The nomograms included twelve 5-year age strata (20-79 years) presented as quartiles, and additional percentiles of the dental parameters for each age group. Cross-sectional data from a conventional dental office (n=186) and from a periodontology unit (n=130, Greifswald) in the study region as well as longitudinal data set of a another periodontology unit (n=135, Kiel) were utilized in order to verify whether the given practice profile was accurately reflected by the nomogram. RESULTS: In terms of tooth loss, the data from the conventional dental office agree with the median from the nomogram. For attachment loss and probing depth, some age groups yielded slight but not uniform deviations from the median. Cross-sectional data from the periodontology unit Greifswald showed attachment loss higher than the median in younger but not in older age groups. The probing depth was uniformly less than the median and tended toward the 25th percentile with increasing age. The longitudinal data of the Unit of Periodontology in Kiel showed a pronounced trend towards higher percentiles of residual teeth, meaning that the patients retained more teeth. CONCLUSION: The profile of the Pomeranian dental office does not deviate noticeably from the population-based nomograms. The higher attachment loss of the Unit of Periodontology in Greifswald in younger age strata clearly reflects their selection because of periodontal disease; the combination of higher attachment loss and decreased probing depth may reflect the success of the treatment. The tendency of attachment loss towards the median with increasing age may indicate that the Unit of Periodontology in Greifswald does not fulfill its function as a special care unit in the older subjects. The longitudinal data set of the Unit of Periodontology in Kiel impressively reflects the potential of population-based data sets as a means for benchmarking. Thus, nomograms can help to determine the practice profile, potentially yielding benefits for the dentist, health insurance company, or--as in the case of the special care unit--public health research.     

Periodontal status of older Floridians attending senior activity centers

Older adults attending senior activity centers in Florida cooperated for a questionnaire and an oral examination. The 671 ambulatory dentate seniors in this report had a mean of 17.0 teeth. The mean attachment loss was 3.5 mm from the cementoenamel junction (CEJ), and the mean pocket depth was 2.1 mm. 24% of the sample had at least 1 site with attachment loss of 7 or more mm; the majority of these persons had only 1 or 2 severely-involved sites. The extent and severity index of attachment loss (2 mm or more threshold) was (88%, 3.7 mm). Use of pocket depths alone would have substantially underestimated prevalence of periodontitis in this older sample. Sites with severe attachment loss were typically not accompanied by severe pockets. Evidence of a history of moderate disease in this cross-sectional study was prevalent (62% of persons had a maximum attachment loss of 4-6 mm), as was evidence of a history of severe disease (24% had at least 1 site with attachment loss of 7 mm or more).     

The effect of smoking on the response to periodontal therapy

Abstract This study evaluated the effect of smoking on the clinical response to non-surgical and surgical periodontal therapy. 74 adult subjects with moderate to advanced periodontitis were treated according to a split-mouth design involving the following treatment modalities: coronal scaling, root planing, modified Widman surgery, and flap with osseous resectional surgery. Clinical parameters assessed included probing depth, probing attachment level, horizontal attachment level in furcation sites, recession, presence of supragingival plaque and bleeding on probing. Data were collected: initially, 4 weeks following phase-I therapy, 10 weeks following phase-II therapy and on a yearly basis during 6 years of maintenance care. Data analysis demonstrated that smokers exhibited significantly less reduction of probing depth and less gain of probing attachment level when compared to non-smokers immediately following active therapy and during each of the 6 years of maintenance (p< 0.05). A greater loss of horizontal attachment level was evident in smokers at each yearly exam during maintenance therapy (p < 0.05). There were no differences between groups in recession changes. In general, these findings were true for the outcomes following all 4 modalities of therapy and were most pronounced in the deepest probing depth category (≥ 7 mm). Statistical analysis showed a tendency for smokers to have slightly more supragingival plaque and bleeding on probing. In summary, smokers responded less favorably than non-smokers to periodontal therapy which included 3-month maintenance follow-up.     

The prevalence of periodontal disease measures in elderly adults, aged 79 and older

From 1996-98, we examined 449 adults (mean age 85 years) from the 1982 Iowa 65⁺ Rural Health Study, in the field using headlight, mirror, and periodontal probe. Ninety-six of the 342 dentate subjects were excluded from the follow-up examination due to contraindications to probing, and 10 could not be assessed due to refusals, fatigue or other reasons. For all remaining subjects (n=236), attachment loss, defined as recession plus probing depth, was determined at four sites per tooth. Ninety-one percent of the subjects had at least one site with 4⁺ mm of attachment loss, 45% had one or more sites with attachment loss of 6⁺ mm, and 15% had 8⁺ mm of attachment loss. Moderate periodontal disease is prevalent among very old dentate adults while advanced periodontal disease is much less prevalent, suggesting that most periodontal treatment needed by this age group can be provided by general dentists and dental hygienists rather than periodontists.     

A comparison of periodontal disease among rural Amish and non-Amish adults

Abstract. Periodontal disease can be more efficiently studied within a homogeneous population where genetic influences and lifestyles are similar enough to negate their effect on the disease process. This study focuses on an Amish population in southern Michigan who isolate themselves from outside influences and their non-Amish neighbors. A total of 425 Amish and 290 non-Amish were contacted resulting in 330 Amish and 215 non-Amish who were examined in their homes giving a participation rate of 76.2%. Ages ranged from 18 to 82 years. Prevalence of periodontal disease tended to be higher among males and increased with age. There were slightly more Amish females (52%) than non-Amish (49%). Means of periodontal conditions for Amish were 1.35 mm for attachment loss, 2.59 mm for pocket depth, 0.24 for calculus, 0.77 for plaque and 0.74 for gingivitis. For non-Amish, the means were 1.03 mm for attachment loss, 2.38 mm for pocket depth, 0.40 for calculus, 0.95 for plaque and 0.87 for gingivitis. It is of interest that the Amish do not practice routine oral hygiene. Only 36.8% of Amish reported brushing at least 1 × a day compared to 84.6% of non-Amish. Similarly, only 8.2% of Amish reported flossing at least 1 × a week compared to 40.8% of non-Amish.     

Speculations on periodontal attachment loss

A hypothesis is presented depicting patterns of human periodontal attachment loss. The patterns described occur rapidly, are site-specific and take place in response to virulence and duration of local irritants. They appear to mirror current clinical observations regarding the nature and progress of site-specific periodontal lesions.     

Comparative estimation of periodontal conditions by means of different index systems

Abstract The aim of the present study was to compare epidemiological data of periodontal disease obtained from a sample of adults by means of different, commonly employed, partial and full-mouth index systems, in order to explore the amount of discrepancy attributed to the methodology per se. 169 dentate subjects, aged 25–64 years, were subjected to a clinical examination, including circumferential probing assessments of pocket depth (PPD) and attachment level (PAL) at all teeth present. The individual mean % of tooth sites with PPD of 6 mm and the % of subjects exhibiting at least one such deep pocket were calculated based on (i) full-mouth data, (ii) data derived from the buccal and mesial surfaces from 1 randomly selected upper and 1 lower quadrant, (iii) probing assessments at the 6 “Ramfjord teeth”, (iv) the full-mouth community pehodontal index for treatment needs (CPITN), and (v) the partial CPITN based on 10 index teeth. The PAL data were analyzed by means of 3 versions of the extent and severity index, 1 generated by full-moutn assessments and 2 by partial assessments based on 28 and 10 tooth sites, respectively. In the entire sample, the individual mean % of sites with PPD of 6 mm generated by the different systems ranged between 5.0 and 4.2 sites/subject. By full-mouth CPITN scorings, an average of 1.0 score-4 sextants/subject was recorded, while the partial CPITN generated a corresponding value of 0.8 score-4 sextants/subject. The prevalence of subjects with at least one deep pocket was found to be (i) 47% by the full-mouth examination, (ii) 24% by the half-mouth examination, (iii) 26% by the use of the “Ramfjord teeth”, and (iv) 44% by the partial CPITN. Variations in the accuracy of the partial recordings were observed in different age groups. Analysis of the PAL data generated extent values ranging between 93 and 96% and severity values between 3.6 and 3.9 mm. It was concluded that partial recording systems (i) provide reasonably valid estimates of the individual mean number of “affected” tooth sites; however, (ii) they grossly underestimate the prevalence of subjects exhibiting deep periodontal pockets.     

Clinical characteristics of periodontal sites with probing attachment loss following initial periodontal treatment

Abstract Periodontal sites which had undergone probing attachment loss were identified in 16 advanced periodontitis patients subjected to initial periodontal treatment and monitored every 3rd month for 42 months. Many sites with probing attachment loss showed no increase in probing depth and bled on probing at a few of the examinations during maintenance. Others showed increase in depth, frequent bleeding and suppuration. An arbitrary classification of ‘questionable periodontitis’ sites was used and included sites with the following characteristics: probing depth at 42 months 3.5 mm + bleeding on probing at no more than 5 of the 14 examinations 3-42 months + no suppuration on probing 3-42 months. The % sites in this category ranged from 21-35%, depending upon method used to determine probing attachment loss. Widely varying characteristics of sites identified with probing attachment loss were evident for all surface locations and all subgroups of initial probing depth. From a traditional viewpoint, a significant proportion of the losing sites might not have been afflicted with periodontitis. On the other hand, deterioration does not necessarily have to be coupled with obvious inflammation, particularly following therapy.     

Prevalence of aggressive periodontitis in school attendees in Uganda

AIM: The prevalence and severity of early onset periodontitis (EOP) among students attending secondary schools in two regions of Uganda was studied. MATERIAL AND METHODS: 690 students (393 males and 297 females) aged 12-25 years (mean 17 years), representing a range of tribal groups, were recruited from six schools in the peri-urban Central and rural Western regions of Uganda. The study subjects were clinically examined in field conditions by a single calibrated examiner to measure gingival recession and probing depth at six sites per tooth, with subsequent calculation of clinical periodontal attachment level for each site. Subjects exhibiting >or= 4 mm of clinical periodontal attachment loss at approximal surfaces of one or more teeth were classified with EOP. A structured written questionnaire obtained demographic characteristics of the study subjects. RESULTS: 199 (28.8%) study subjects showed clinical features of EOP, of which 16 (2.3%) subjects exhibited generalized EOP, 29 (4.2%) localized EOP, and 154 (22.3%) incidental EOP. The percentage of EOP-affected males was significantly higher than females (33.8% vs. 22.2%, P < 0.001). EOP prevalence tended to increase with increasing age, but no association was found between EOP prevalence and socioeconomic status or residency in urban vs. rural areas of Uganda. Molars and mandibular incisors generally demonstrated the highest occurrence of >or= 4 mm attachment loss. Clinical periodontal attachment loss of >or= 5 mm was mainly seen at first molars and incisors, suggesting that these two tooth types are first affected with attachment loss. Approximal tooth surfaces showed greater probing depth and attachment loss than buccal and lingual surfaces. Gingival recession was most prevalent at mandibular anterior teeth, whereas gingival margin coronal to CEJ was most frequently observed at second molars and maxillary incisors. CONCLUSION: A relatively high prevalence of EOP (28.8%) was found in young Ugandan school attendees, with 6.5% of these showing severe disease. EOP in Uganda was significantly more prevalent in males than females, and most frequently characterized by approximal involvement of molars and mandibular incisors. Etiologic and predisposing factors associated with the high occurrence of EOP in Uganda, as well as therapeutic and preventive measures of the disease in this population, remain to be delineated.     

Relationship of clinical parameters to attachment loss in subsets of subjects with destructive periodontal diseases

23 subjects were followed prior to treatment for 5 to 12 months in an attempt to relate attachment loss during this period to attachment level, probing depth, gingival redness and bleeding on probing. The subjects were divided into 3 groups based on amount and distribution of prior attachment loss: minor periodontitis, predominantly molar periodontitis and generalized periodontitis. The % of sites that exhibited attachment loss during the study period in the minor periodontitis, predominantly molar periodontitis and generalized periodontitis groups, were 1.3, 8.1 and 5.4, respectively. Subjects with minor periodontitis and predominantly molar periodontitis exhibited attachment loss more frequently in molar sites, proximal sites and sites with attachment level greater than or equal to 4 mm. In subjects with generalized periodontitis, attachment loss was related to tooth surface and attachment level, but not to tooth type. The relationship between the clinical parameters and attachment loss was improved compared with previous studies by using more homogeneous subject groups, more sensitive methods of analyzing attachment change and multivariate data analysis. However, the clinical parameters could not be used as diagnostic tests to predict attachment loss at individual sites.     

Management of shortened dental arches and periodontal health: 5‐year results of a randomised trial

In a multicentre randomised trial (German Research Association, grants DFG WA 831/2‐1 to 2‐6, WO 677/2‐1.1 to 2‐2.1.; controlled‐trials.com ISRCTN97265367), patients with complete molar loss in one jaw received either a partial removable dental prosthesis (PRDP) with precision attachments or treatment according to the SDA concept aiming at pre‐molar occlusion. The objective of this current analysis was to evaluate the influence of different treatments on periodontal health. Linear mixed regression models were fitted to quantify the differences between the treatment groups. The assessment at 5 years encompassed 59 patients (PRDP group) and 46 patients (SDA group). For the distal measuring sites of the posterior‐most teeth of the study jaw, significant differences were found for the plaque index according to Silness and Löe, vertical clinical attachment loss (CAL‐V), probing pocket depth (PPD) and bleeding on probing. These differences were small and showed a slightly more unfavourable course in the PRDP group. With CAL‐V and PPD, significant differences were also found for the study jaw as a whole. For CAL‐V, the estimated group differences over 5 years amounted to 0·27 mm (95% CI 0·05; 0·48; P = 0·016) for the study jaw and 0·25 mm (95% CI 0·05; 0·45; P = 0·014) for the distal sites of the posterior‐most teeth. The respective values for PPD were 0·22 mm (95% CI 0·03; 0·41; P = 0·023) and 0·32 mm (95% CI 0·13; 0·5; P = 0·001). It can be concluded that even in a well‐maintained patient group statistically significant although minor detrimental effects of PRDPs on periodontal health are measurable.     

青海省人群牙周健康状况流行病学调查报告

目的了解青海省人群牙周健康的状况,为牙周疾病的防治提供基线资料。方法根据第三次全国口腔健康流行病学调查牙周状况的检查标准,采用多阶段、分层、等容量、随机抽样的方法,对青海省12、35～44和65～74岁3个年龄组的牙龈出血、牙结石、牙周袋及附着丧失等进行流行病学抽样调查。结果1）青海省12、35～44、65～74岁年龄组牙龈出血检出率分别为98.74%、97.84%和92.23%,牙结石检出率分别为89.76%、99.87%和92.87%。2）35～44岁年龄组浅牙周袋检出率为34.64%,深牙周袋检出率为5.58%;65～74岁年龄组浅牙周袋检出率为50.45%,深牙周袋检出率为13.12%。3）35～44岁年龄组附着丧失4～5、6～8、9～11、12 mm或以上的检出率分别为40.74%、18.78%、4.82%、1.78%;65～74岁年龄组附着丧失4～5、6～8、9～11、12 mm或以上的检出率分别为71.21%、51.34%、20.51%、7.01%。结论青海省人群口腔卫生状况很差,中老年人牙周袋及附着丧失的程度比较严重,必须加强对牙周疾病的预防。     

Impact of periodontitis definition in epidemiological research. Results from the EPIPAP study in postpartum women

The purpose of this investigation was to study the impact of using various definitions of periodontitis on the frequency of periodontitis and on the associations with some known risk factors for periodontitis in a population of postpartum women in France. A clinical examination was performed within 2-4 d postpartum in 932 at-term women at five maternity units. We studied six definitions of periodontitis; five were applicable if at least two teeth were found to have the following: (i) a proximal clinical attachment level (CAL) of ≥ 3 mm; (ii) a probing depth (PD) of ≥ 4 mm; (iii) a PD of ≥ 4 mm and a CAL of ≥ 3 mm at the same site; (iv) a proximal PD of ≥ 5 mm or a proximal CAL of ≥ 4 mm; or (v) a PD of ≥ 4 mm and a CAL ≥ 3 mm and bleeding on probing at the same site. The sixth definition required the involvement of four teeth with a PD of ≥ 4 mm and a CAL of ≥ 3 mm at the same site. Associations between case status according to each definition and maternal characteristics (age, educational level, smoking before pregnancy, and time since last dental visit) were analyzed using generalized estimating equation models. The definition of periodontitis had an impact on the frequency of periodontitis, which ranged from 12.1% to 37.7%, and produced different ORs for the associations with risk factors for periodontitis.