Periodontal treatment needs in populations under 20 years of age in Espoo, Finland and Chiangmai, Thailand

The aim of this study was to assess the periodontal treatment needs at under 20 yr of age in the affluent area of Espoo, Finland, offering comprehensive public dental health care, as compared to a less advantaged area in Chiangmai, Thailand. In Espoo, 50 girls and 50 boys were examined in each age group of 7, 12 and 17 yr. In Chiangmai equal numbers of girls and boys were examined to obtain a group of 89 subjects aged 18.5 + 0.6 yr. According to the Community Periodontal Index of Treatment Needs (CPITN) the need of scaling increased in Espoo from 6% of the 7-yr-olds to 39% of the 17-yr-olds. Moderate pocketing (4-5 mm) occurred in one subject at age 12 and in three subjects at age 17. In Chiangmai, deep pockets (6 mm and over) were recorded for 1%, moderate pockets for a total of 44%, and dental calculus as the highest treatment need indicator in the remaining 55%, indicating a need for professional treatment in 100% of the group examined. The mean number of sextants requiring scaling was 0.6 per person at age 17 in Espoo as compared to 4.5 at 18.5 yr of age in Chiangmai. Three or more healthy sextants per subject were recorded for 47% of the 17-yr-olds in Espoo and for only 6% of the 18.5-yr-olds in Chiangmai. It was concluded that already at young age vast differences occur between periodontal treatment needs in industrialized and developing countries.     

Periodontal treatment needs, by CPITN, among employees of a Jerusalem hospital.

A survey, employing the Community Periodontal Index of Treatment Needs (CPITN), was conducted among 344 employees of a Jerusalem hospital. Of the population surveyed, 2.2 per cent demonstrated totally healthy mouths, 1.5 per cent had, at the worst, bleeding symptoms, 13.3 per cent had calculus, 53.4 per cent had 4-5 mm ('shallow' according to WHO) pockets and 29.6 per cent had deep pockets (6 mm or more) as their worst CPITN scores. Results revealed an average of 0.55 edentulous sextants, 0.68 healthy sextants, 0.87 sextants with bleeding symptoms, 1.36 with calculus, 1.95 with 4-5 mm pockets and 0.61 sextants with deep pockets. In general, females were healthier than males, had a significantly greater number of healthy sextants, less sextants with calculus and less sextants with deep pockets. A deterioration in periodontal health with age was evident, according to mean number of sextants per person by CPITN scores. Associations were also analysed between CPITN and demographic variables. Few significant associations were revealed. Based on FDI and WHO estimates, the calculated periodontal treatment needs for the hospital employees was found to be about 2 hours per person. Compared with data for other countries, as reported by the WHO, this status demands serious efforts to be made towards periodontal health promotion.     

Periodontal status and treatment needs in the Chiangmai/Lamphun provinces of Thailand

As part of an oral health survey concerned with the evaluation of a collaborative primary oral health care program, the CPITN system was used to determine the periodontal status and treatment needs of 2009 Thai people aged 12-44 yr. Calculus dominated the CPITN scores. The percentage of persons with healthy periodontal tissues was small, ranging from 0.7% at age 35-44 to 4.1% at age 12. Ranges for other highest scores were bleeding-0.4% at age 35-44 yr to 6.1% at age 12 yr; calculus-62% at age 35-44 yr to 92.6% at age 17-18 yr. Pocketing did not occur to any significant extent until age 35-44 where 23.9% had 3-5 mm pockets and 12.8% had pockets 6 mm or deeper. 15-18-yr-olds who had received prior care from a Village Scaler had a significantly higher number and proportion of healthy sextants than those who had not received such care. No such effect was demonstrated in 35-44-yr-olds. The need for caution in the interpretation of this result is stressed. Attention is drawn to the desirability of differentiating between supra- and sub-gingival calculus in the CPITN scoring system and to the excessive treatment requirements that arise from classifying everyone with calculus as requiring prophylaxis and scaling. A great deal of improvement will need to be affected if the Thai national and global goals for periodontal health are to be achieved in the districts covered by this survey.     

Periodontal treatment need of the 6th-grade Jordanian pupils

AIM: The purpose of this study was to assess the periodontal treatment needs of 6th-grade Jordanian pupils aged 12 years old. METHODS:Forty-eight classes teaching 6th-grade pupils were randomly selected from the six education zones in Irbid region, Jordan. The data were collected during interviews and clinical examinations using the Community Periodontal Index of Treatment Needs (CPITN) criteria. RESULTS: The findings revealed that 27.5% of the examined pupils had healthy periodontium, 22.9% showed gingival bleeding on probing but no calculus, and 31.4% had calculus deposits. Pockets in the 4-5 mm range were found in 17.6% and those in the>6 mm range in 0.6% of the pupils. Healthy periodontium was found in 2.9 sextants, whereas 2.7 sextants showed gingival bleeding and calculus. Periodontal pockets were demonstrated in less than 0.4 sextants. Periodontal therapy was not required for 27.5% of the pupils. The rest of the pupils (72.5%), however, needed oral hygiene improvement, and of these 50% required professional calculus removal. CONCLUSION: This study indicated that about 73% of the sample needed oral hygiene instructions and motivation, 50% needed professional scaling, and 0.6% needed periodontal therapy. The data of this study establish a baseline data, which may help in planning dental services and initiating further research.     

Assessment of periodontal status and treatment needs of a disabled population using the CPITN.

The Community Periodontal Index of Treatment Needs (CPITN) was used to assess the periodontal status of 213 handicapped persons attending seven institutions in Johannesburg. Fewer than 2% had healthy mouths, 8% had bleeding only, followed by calculus (46%), shallow pockets (40%) and deep pockets (4%). The mean number of sextants with bleeding or higher score was 5.9. Oral hygiene instruction was indicated for 98% and prophylaxis for 90% of the participants. The CPITN was easily used in the disabled population but may overestimate treatment need in view of the current understanding that periodontal disease does not automatically progress from a low CPITN level to the next. A more appropriate measure of treatment need in handicapped persons is required.     

Periodontal conditions among the middle-aged and the elderly in Hong Kong

Abstract The aim of this study was to describe the periodontal conditions in 372 35–44-yr-old and 537 noninstitutionalized 65–74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (≥6, ≥9, and ≥12 mm, respectively). The mean numbers of teeth with loss of attachment at the ≥6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths ≥6-mm, while al the ≥9-mm threshold only 2–3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds ≥4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65–74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as “healthy” (CPI code 0) or had “bleeding only” (code 1) as their highest score. While most subjects scored CPI code 2 or 3 us their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4. Differences in the mean number of sextants affected by CPI codes between the two cohorts were mainly due to a greater number of excluded sextants in the older cohort. CPI findings for 35–44-yr-olds differed little from those reported in 1984.     

The use of the CPITN to monitor the outcome of periodontal treatment in a dental hospital setting.

The Community Periodontal Index of Treatment Need (CPITN) is recommended for monitoring the outcome of periodontal treatment, yet to date there is only one published prospective study that has used the index for that purpose. The aim of the present study was to monitor the outcome of periodontal treatment of 42 patients referred to a consultant periodontist in a dental hospital. The CPITN was recorded at baseline by a single trained examiner. Subsequently, the patients were examined independently by the consultant and a treatment plan formulated. The prescribed treatment was carried out, and a record was maintained of the type of treatment provided and the number of visits involved. The CPITN was recorded again approximately 6 months after baseline by the same trained examiner. Full data were obtained for 36 subjects; most (22 patients) had deep pockets (CPITN, code 4) at baseline, while nine had shallow pockets (CPITN, code 3). Patients with deep pockets at baseline required more complex treatment and more visits (mean 6.2 visits) than patients with shallow pockets, calculus or gingival bleeding (mean 3.5 visits). Nineteen of the 22 subjects with deep pockets at baseline showed a reduction in the number of sextants with deep pockets after 6 months; however, in only 11 of these subjects were the number of sextants with deep pockets reduced to zero. In the light of these findings a modified format for summarising such CPITN data is recommended.     

Periodontal health status of school children in St. Vincent and the Grenadines.

A national oral health survey of school children was conducted in October through November 1991. The objective was to determine the periodontal status of school children in St. Vincent and The Grenadines (SVG), the pattern and severity of periodontal disease, estimate treatment needs and provide information for health planners. The study had a cross-sectional design, and 1646 schoolchildren representing all school districts were selected via multistage, systematic sampling. Examinations were conducted by three examiners using CPITN probe. Periodontal indicators and treatment needs were determined using the CPITN index. Calculus was the most prevalent condition with values ranging from 26 to 83 percent, bleeding was the least prevalent condition, while children with healthy indicator were intermediate in prevalence. Subjects with healthy indicators ranged from a low of 12 percent among 15-19 year olds, to a high of 51 percent among seven-year-olds. The mean number of healthy sextants varied from three to five, and mean number of sextants with bleeding or calculus varied from one to three. Oral hygiene instruction (OHI) was the most common treatment need, ranging from 49 to 88 percent. The need for prophylaxis was associated with increase in age, with the highest prophylaxis treatment needs of 83 percent, among 15-19 year olds. No significant differences were observed in periodontal status between gender, and also between urban and rural children. A high prevalence of calculus and bleeding was observed among SVG school children. Study recommends initiation of primary prevention programs in form of health promotion and health education.     

Periodontal treatment needs in populations of high- and low-fluoride areas of Morocco

The purpose of this study was to determine the periodontal status and treatment needs, using the CPITN index, in a population aged 7 to 60 years residing in the fluorosis area of Khouribga and the non-fluorosis area of Beni-Mellal, Morocco. A total of 2378 subjects was studied. In the youngest age groups, more subjects and sextants from Khouribga than from Beni-Mellal were free of periodontal diseases. Conversely, in Beni-Mellal, subjects in the youngest age groups presented a higher mean number of sextants with calculus than those from Khouribga. In combining the 2 areas, 1.3% of the 2319 dentate subjects examined needed no treatment and 98.7% needed at least oral hygiene instructions (TN1). The present study, based on the CPITN index, demonstrated in both areas a high prevalence of gingivitis, and a relatively low prevalence of deep pocketing, occurring on the average in less than half a sextant in the total populations.     

Application of the community periodontal index of treatment needs (CPITN) in a group of 45–54-year-old German factory workers

Abstract The purpose of the present study was to assess the periodontal status of 45–54-year-old patients and to evaluate their treatment needs. Probing depths, bleeding on probing and retentional elements (calculus and overhanging restorations) were determined according to the community periodontal index of treatment needs (CPITN). Additionally, loss of attachment was measured, Results indicated that none of the subjects had a completely healthy periodontium; only 14.7% presented with single sextants which were healthy or needed only improved oral hygiene. Slightly less than half (46.1%) of the subjects were classified as treatment need (TN) category 2 and the remainder (53.9%) as TN3. Of the subjects classed as TN category 3, 14% had the requisite code 4 in one sextant, 18.2% in 2 sextants. 21.7% in half or more of the sextants and 4.2% in all sextants. With a mean of 5.55 sextants per patient. 0.2 sextants per person were scored as code 0 or 1, 1.33 sextants as code 2, 2.79 sextants as code 3 and 1.24 sextants as code 4. The mean loss of attachment was 3.8 mm. Anterior teeth showed less loss of attachment than posterior teeth and buccal and lingual surfaces showed less loss of attachment than mesial and distal surfaces. The data indicate that although this group of 45–54-year-old subjects had high CPITN scores in total TN categories, the codes for complex Treatment Needs (TN3) were recorded only in localized areas.     

Presence and absence of bleeding in association with calculus in segments given Code 2 in the Community Periodontal Index of Treatment Needs (CPITN)

The periodontal status of 257 Japanese company employees aged 20-56 yr was studied to determine the number and percentage of subjects with and without bleeding after gentle probing in the sextants given a Code 2 using the CPITN. In addition to recording the presence of calculus in the conventional manner, a modification was introduced to add a Code 2+ for sextants in which bleeding after probing was found and a Code 2- where no bleeding was detected. The results indicate that 38-52% of the sextants given a Code 2 showed no bleeding after probing. Such a large percentage of sextants with no evidence of bleeding in the presence of calculus raises a question about the priority which should be accorded to provide scaling for these subjects. The results also show that of the 116 subjects aged 20-29 yr judged to be in need of periodontal treatment by the CPITN criteria 18.1% showed neither pocket formation nor bleeding. Modifications to the CPITN are suggested which should make the index more appropriate for assessing both the prevalence of periodontal disease and the need for periodontal treatment and thus make it more useful for public health planning and evaluation purposes.     

Periodontal treatment needs in a population of Ljubljana, Yugoslavia

1692 citizens of Ljubljana in the age range from 15 to 65 yr participated in a survey to assess their periodontal treatment needs. Eighty-three of the participants (4.9%) were edentulous and excluded from the study. Of the 1609 dentate subjects only 2.4% were free of any signs of periodontal disease. According to the Community Periodontal Index of Treatment Needs, (CPITN), reversible gingivitis was present in 19.9% of the population, calculus and shallow pockets (4-5 mm) in 57.4%, and deep pockets (greater than or equal to 6 mm) in 20.3% of the examined participants. Bleeding on probing was the most common finding in a group of 15-yr-old subjects, calculus was most frequently found in 25- and 35-yr-old groups, and shallow and deep pockets in 45-, 55- and 65-yr-old adults. Complex treatment needs increased with age, reaching 42.9% in the 65-yr-old population. However, deep pocketing was in 60% limited to one sextant of the participants with complex treatment needs.     

Profiles of periodontal conditions in older age cohorts, measured by CPITN.

Results of more than 80 CPITN surveys from almost 30 countries for the age groups of 45 years and above are assembled. In this first overview, data for the older age cohorts are presented, showing the percentages of persons according to the highest score per person and the mean numbers of sextants affected per person. Results for three age groups are presented: 45-54, 55-64 and 65-74 years, with two additional surveys in older persons. There were marked variations in periodontal conditions between surveys. The assumed differences between industrialized and non-industrialized countries with regard to periodontal diseases did not show in the data examined. Also, the expected increase in periodontal destruction with increasing age was not reflected in values for pocketing or deep pocketing in the successive age groups. Some variations between surveys was also noted for the rate of tooth loss, expressed in the mean number of excluded CPITN sextants. However, on average, at age 50, almost one sextant was excluded, increasing to 1.5 sextants at 60 and almost 2.5 sextants at age 70. It is therefore suggested that the progress of periodontal destruction with age is not shown in an increase in periodontal CPITN scores, but in increased tooth loss, specified by an increasing number of excluded CPITN sextants. For the age group 65-74 years, this results in, on average, almost half of all sextants being excluded. Of the remaining sextants, approximately half had shallow and/or deep pockets.     

Community periodontal index of treatment needs and prevalence of periodontal conditions

BACKGROUND/AIMS: In 1977, the World Health Organization (WHO) proposed a new index, the community periodontal index of treatment needs (CPITN) to evaluate the periodontal treatment needs of populations. The aim of this study is to compare different approaches of recording and presenting the CPITN. METHODS: A sample of 2110 subjects aged 35-44 years were examined between September 1994 and July 1995, throughout the province of Quebec, Canada. For each tooth (3rd molars excluded), the presence of bleeding and calculus, the level of epithelial attachment, and the depth of periodontal pockets were measured. Periodontal pocket depths were measured from the edge of the free gingiva, at 2 sites (mesiovestibular and vestibular), as well as all around the tooth. RESULTS: Only 8.5% of adults had at least one tooth with a 6 mm or deeper periodontal pocket when probing on 2 sites, whereas if probing is done all around the tooth, this percentage is 2.5x higher (21.4%). The partial recording of pocket depths (10 index teeth recommended by WHO, or 2 quadrants chosen at random) resulted in an underestimation of the prevalence of subjects with at least one tooth with a periodontal pocket (CPITN score 3 and 4). Among subjects with at least one tooth with a 6 mm or deeper periodontal pocket, 12% were not detected with the 10 index teeth recording, and 25% go undetected with the measure on 2 quadrants. Finally, using the % of subjects with periodontal pockets overestimates the prevalence of deep pockets compared with using sextants. Indeed, close to 30.0% of sextants have no treatment needs, whereas only 5.2% of subjects are in this category. Similarly, 7.7% of sextants have at least one tooth with a 6 mm or deeper periodontal pocket, yet there are 3x more subjects in this category (21.4%).     

Periodontal conditions among the old elderly: five-year longitudinal study

In the past three decades, there has been a significant rise in the number of old elderly (85+ years old) in Finland, and more of these individuals are retaining their natural teeth. Numerous cross-sectional studies have reported on the periodontal health of the elderly (aged 75+), but very few long-term follow-ups have been reported. This study forms a part of the population-based Helsinki Aging Study (HAS) and compares the periodontal health status and the treatment needs at baseline with those of the same population five years later. The baseline study, in 1990–91, examined the dentate elderly born in 1904, 1909, and 1914, living in Helsinki, Finland (n = 196). The follow-up study was completed in 1995–96 (n = 73). Periodontal status was recorded by means of the Community Periodontal Index of Treatment Needs (CPITN) in 175 dentate subjects (55 males and 120 females) who met the criteria at baseline, and in 57 dentate elderly (17 males and 40 females), aged 81, 86, and 91 years, who remained at follow-up. Among the 57 dentate elderly who participated in both baseline and follow-up examinations, the mean number of teeth decreased from 15.9 to 15.1, and the mean number of remaining sextants from 4.2 to 3.7. There were minor changes in the periodontal health status during this five-year period, with an increase in code 2 (from 43% to 58%) and a decrease in code 3 (from 38% to 25%). Nevertheless, the overall treatment needs remained unchanged. It can be concluded that the periodontal health of the elderly had remained stable for 5 years, and almost no change was observed in their treatment needs. Therefore, periodontal disease in the elderly who are relatively healthy is not caused by the aging process.     

Relationship between CPITN and periodontal attachment loss findings in an adult population

Abstract This study investigates the relationship between CPITN findings and the prevalence and severity of periodontal attachment loss in a rural Kenyan population comprising 1131 persons aged 15–65 years. All persons were examined for calculus, gingival bleeding, pocket depths and attachment loss levels on 4 sites of each tooth present. Recordings of bleeding, calculus and pocket depths were used to compute CPITN scores based on the 10 index teeth originally proposed, and these CPITN scores were subsequently related to the attachment loss findings derived from the full-mouth assessment. In most cases, persons with a CPITN score 1 did not have attachment loss 4 mm. However, among 40+ year-old persons with CPITN score 2 over 90% had attachment loss 4 mm and over 50% of the 50+ year-olds with CPITN score 2 had attachment loss 6 mm, Less than 20% of the 15–29 year-olds with CPITN score 3 had attachment loss 6 mm, and usually the attachment loss levels ranged between 0 and 3 mm. Beyond the age of 35 years over 10% of the sextants with CPITN score 0 had attachment loss 4 mm. Below the age of 35 years more than one third of all sextants with CPITN score 3 had attachment loss levels 3 mm. Thus, the CPITN findings overestimate both prevalence and severity of periodontal attachment loss among the younger age groups and underestimate these parameters among elderly subject.     

Sex differences in the periodontal status of Hong Kong adults aged 35-44 years

Epidemiological studies on periodontal diseases conducted in many countries employing different indices have generally shown advanced periodontal destruction to be more prevalent in adult males than in adult females. The 1984 Hong Kong survey of adult oral health, using the Community Periodontal Index of Treatment Needs (CPITN) to determine periodontal status, revealed that in males aged 35 to 44 years the prevalence of deep pockets was 23 per cent, compared with 9 per cent in females (P less than 0.01). Males had a mean of 0.4 sextants with deep pockets whereas females had a mean of only 0.1 sextants so affected (P less than 0.01). Females were found to have a significantly larger proportion of healthy sextants (P less than 0.01). The observed sex difference in disease prevalence may have been influenced by the fact that fewer teeth were present in the females, but it could not be explained by differences in reported oral hygiene measures and practices.     

Influence of CPITN partial recordings on estimates of prevalence and severity of various periodontal conditions in adults

Abstract – This study compares the results of a lull mouth examination with the results of examining only the CPITN selection of 10 index teeth 17/16, 11, 26/27, 47/46, 31 and 36/37 for estimates of prevalence and severity of the conditions assessed with the CPITN, i.e. gingival bleeding, dental calculus, pockets 4–5 mm deep and pockets 6+ mm deep. The mean number of sextants recorded with bleeding or with calculus was generally overestimated when examinations were based on the CPITN selection of index teeth, whereas the mean number of sextants with pockets, whether moderate or deep, were generally underestimated. Similarly, the prevalence of pockets, whether moderate or deep, was underestimated in virtually all age groups while the prevalence of calculus was overestimated in all age groups and the prevalence of bleeding was overestimated among persons below 30 yr of age. We conclude that the partial recording approach of the CPITN methodology is reasonably well suited for identifying persons who are relatively healthy according to the hierarchy of the CPITN parameters. There is, however, a considerable risk that persons presenting with the more severe conditions, i.e. pockets, will be overlooked if only partial recordings are performed.     

CPITN assessment of periodontal disease in diabetic patients

The aim of this study was to investigate, using the CPITN system, the periodontal treatment needs in diabetic patients, and to shed additional light on the possible effects of the duration and control of diabetes on the periodontal status in these patients. A comparison was made between 222 diabetic patients (mean age, 46.9 years) and 189 control subjects (mean age, 43.9 years). Edentulous patients were not included in the study. The results indicated that diabetic patients demonstrated significantly more missing teeth (P less than 0.001). The mean number of missing sextants was also significantly higher in diabetics. Pathologic pockets of 6 mm or more were found in 1.3 and 0.3 sextants in the diabetic and control group subjects, respectively (P less than 0.001). Up to the age of 34, no differences were observed between the diabetic and control group subjects regarding pathologic pockets of 6 mm or more. Above this age, diabetics demonstrated significantly more sextants with deep pockets (P less than 0.001). Concerning the type of diabetes, no differences related to CPITN score were found between insulin dependent and non-insulin dependent diabetics. Neither were any differences found in the periodontal condition related to the duration and control of diabetes, whereas diabetics with advanced retinopathy demonstrated more sextants with deep pockets. Oral hygiene instructions and scaling were required in all patients from both study groups. On an average, 1.3 sextants in 50.9% of diabetics and 0.3 sextants in 17.9% of control subjects required complex treatment.     

A longitudinal evaluation of Periodontal therapy using the CPITN index

A retrospective 3-year longitudinal evaluation of periodontal therapy using the CPITN index was performed. Each sextant in 123 patients exhibiting moderate to advanced adult periodontitis was given a score that recorded the condition of the worst affected site in that sextant. Whereas very few sextants had an initial CPITN Code 0, the prevalence of sextants with an initial CPITN Code 4 was quite high. Posterior sextants with CPITN Code 4 were more likely treated with surgery than sextants with CPITN Code 3. Although surgery appeared to be more effective than non-surgical therapy in reducing the CPITN Codes for posterior sextants at 1 year, there were no differences between the 2 forms of therapy at the 3-year examination. Anterior sextants were treated with a non-surgical approach regardless of CPITN Code at either initial examination or reevaluation. The outcome of therapy in this study using the CPITN index is comparable to other studies utilizing mean pocket depth and attachment level. Although the CPITN index does not prescribe specific therapeutic interventions, this index provides a useful tool to monitor patients in the treatment of periodontitis.