Frequency distribution of individuals aged 20–70 years according to severity of periodontal disease

Abstract This study is an analysis of the findings in an epidemiologic investigation covering a random sample of 600 individuals aged 20–70 years resident in the city of Jönköping, Sweden. The frequency distribution of individuals according to severity of periodontal disease was determined. The analysis was based on clinical registration of gingivitis, pocket depths and qualitative and quantitative changes of the alveolar bone in a full mouth intraoral survey. In the age groups 20 and 30 years, 96% and 85 % of the individuals, respectively, had healthy periodontal tissues or were grouped as having gingivitis without signs of lowering of the periodontal bone level. In the age groups 40, 50 and 70 years none of the subjects was free from signs of gingivitis/periodontitis but, as for all age groups, strikingly few cases (at most 8%) of severe destructive periodontitis were found. The need for periodontal treatment is discussed as well as the role of specific etiologic agents in the development of destructive periodontal disease.     

Longitudinal study of periodontal status in individuals aged 15 years in 1973 and 20 years in 1978 in Jönköping, Sweden

Abstract The aim of this investigation was to study the periodontal status at the ages of 15 and 20 years in the same individuals. Gingival and periodontal data from 100 adolescents in 1973 constituted the basic material. Eighty subjects could rereexamined in 1978. The mean number of teeth per subject was 27.1 both in 1973 and in 1978. Three individuals in 1973 and two in 1978 had no bleeding gingival units. There was a decrease between 1973 and 1978 in the number of subjects with a high number of inflamed gingival units. The buccal and lingual surfaces also showed lower prevalence of gingivitis, while the proximal surfaces showed a slight increase in prevalence. The prevalence of surfaces with plaque in 1978 was decreased for buccal and lingual surfaces but slightly increased for proximal surfaces. Sixty-six individuals in 1973 and 71 in 1978 had no pocketing. Altogether 75 tooth surfaces with pocketing were diagnosed in 1973 and 21 in 1978. Most of the pockets were located at the proximal surfaces of the molars. Four individuals with infra bony defects in one to two sites were found in 1973 and five in 1978. No progression of the bony defects found in 1973 seemed to have occurred during the 5-year period. In spite o(the frequent proximal areas with gingivitis, very few 20-year-olds showed signs of marginal bone loss, which indicates that gingivitis does not necessarily lead to destructive periodontitis in young people.     

Distribution of periodontal disease in a Swedish adult population 1973, 1983 and 1993

Abstract. The aim of this study was to compare changes in periodontal status in a Swedish poplation over a period of 20 years. Cross-sectional studies were carried out in Jönköping County in 1973, 1983, and 1993. Individuals were randomly selected from the following age groups: 20, 30, 40, 50, 60, and 70 years. A total of 600 individuals were examined in 1973, 597 in 1983, and 584 in 1993. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. Based on clinical data and full mouth intra-oral radiographs, all individuals were classified into 5 groups according to the severity of the periodontal disease experience. Individuals were classified as having a healthy periodontium (group 1). gingivitis without signs of alveolar bone loss (group 2), moderate alveolar bone loss not exceeding 1/3 of the normal alveolar bone height (group 3), severe alveolar bone loss ranging between 1/3 and 2/3 of the normal alveolar bone height (group 4), or alveolar bone loss exceeding 2/3 of the normal bone height and angular bony defects and/or furcation defects (group 5). During these 20 years, the number of individuals in groups 1 and 2 increased from 49%. in 1973 to 60% in 1993. In addition, there was a decrease in the number of individuals in group 3, the group with moderate periodontal bone loss. Groups 4 and 5 comprised 13% of the population and showed no change in general between 1983 and 1993. The individuals comprising these groups in 1993, however, had more teeth than those who comprised these groups in 1983; on the average, the individuals in disease group 4 had 4 more teeth and those in disease group 5, 2 more teeth per subject. ID 1973, these 2 groups were considerably smaller, probably because of wider indications for tooth extractions and fewer possibilities for periodontal care which meant that many of these individuals had become edentulous and were not placed in a group. Individuals in groups 3, 4, and 5 were subdivided according to the number of surfaces (%) with gingivitis and periodontal pockets (≥4 mm). In 1993, 20%, 42%, and 67% of the individuals m groups 3, 4, and 5 respectively were classified as diseased and in need of periodontal therapy with >20% bleeding sites and >10% sites with periodontal pockets ≥4 mm. In conclusion, an increase in the number of individuals with no marginal bone loss and a decrease in the number of individuals with moderate alveolar bone loss can be seen. The prevalence of individuals in the severe periodontal disease groups (4, 5) was unchanged during the last 10 years; however, the number of teeth per subject increased.     

Prevalence of deep periodontal pockets in New Mexico adults aged 27 to 74 years

The purpose of this study was to describe the distribution of advanced periodontal destruction (pocket depth equal to or deeper than six mm) in continuous residents, aged 27 to 74 years, of Lordsburg and Deming, New Mexico. The distance from the free gingival margin to the base of the gingival crevice or pocket was measured on the facial and mesiofacial sides of six index teeth. The presence of supragingival calculus, subgingival calculus, and plaque, as well as gingival bleeding around the index teeth, also were evaluated. Of the 372 examinees, only 46 individuals (12.4 percent) had at least one deep pocket equal to or deeper than six mm on at least one site on the six index teeth. Age was significantly associated with prevalence of deep pockets, although about 80 percent of those aged 47 to 74 years did not have deep pockets. Of those with deep pockets, 89.1 percent had fewer than four tooth sites (out of 12) affected. The only significant risk factor of the presence of deep pockets, other than age, was the number of teeth with plaque accumulations. Age and the number of teeth with plaque explained only 10.5 percent of the variability in the prevalence of deep pocketing, suggesting that risk factors other than those included in this study may be important. The results of this study indicate that destructive periodontal disease occurs at selected sites within the mouth, and that about 87 percent of the adults over age 27, in this population, do not have deep pockets in the six index teeth examined.     

Trends over 30 years, 1973-2003, in the prevalence and severity of periodontal disease

Aim: The present investigation presents findings of the prevalence and distribution of gingivitis and periodontitis in a Swedish population over the 30 years 1973–2003. Material and Methods: Four cross‐sectional epidemiological studies in 1973, 1983, 1993, and 2003 were performed in Jönköping, Sweden. Random samples of individuals aged 20, 30, 40, 50, 60, 70, and 80 years were examined clinically and radiographically. Diagnostic criteria were edentulousness, number of teeth, plaque, gingival status, probing pocket depth, gingival recession, alveolar bone level, and classification according to periodontal disease status. Results: In all age groups, the number of edentulous individuals decreased dramatically and the number of teeth increased. Oral hygiene improved considerably. Over the 30 years, the proportion of periodontally healthy individuals increased from 8% in 1973 to 44% in 2003 and the proportion of individuals with gingivitis and moderate periodontitis decreased. There was a non‐significant trend for the proportion of individuals with severe periodontal disease experience (Group 4) to decrease, while the proportion of individuals with advanced periodontitis (Group 5) remained unchanged. Conclusion: Oral hygiene and periodontal health improved significantly in the 20–80‐year age groups over the 30 years 1973–2003.     

Oral hygiene and gingivitis in a Swedish adult population 1973, 1983 and 1993

Abstract. The periodontal condition of the inhabitants of Jönköping County, Sweden was followed for 20 years by means of 3 cross-sectional investigations performed in 1973, 1983, and 1993. The study comprised individuals in the age groups 20, 30, 40, 50, 60, and 70 years. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. All individuals participating in the studies were examined clinically and radiographically. They also filled out a questionnaire about dental care habits, socio-economic status, and general health. A clear reduction in the plaque score was seen between 1973 and 1983 in all age groups. With one exception, no further significant change in plaque levels was found between 1983 and 1993: the increase in plaque among the 20-year-olds was significant. In 1993 the mean % of surfaces with plaque was between 30% and 40% in all age groups. Gingivitis values corresponded well with the values of dental plaque: the same pattern with a clear reduction in gingivitis score was seen in all age groups between 1973 and 1983, and an increase in the mean frequency of gingival inflammation between 1983 and 1993 was seen in the 20-year age group. 30% of the individuals in this age group had more than 50% gingivitis in 1993 compared with 9% of the individuals in 1983. The 20-year-olds were further analyzed in a linear regression model using gingivitis as a dependent variable against some socio-economic, general health, and dental care variables associated with poor oral hygiene and gingivitis. In 1993, the most important explanatory variable was gender: significantly more males than females had higher gingivitis scores. The second most important explanatory variable was toothbrushing habits. Together they explained 10.9% of the variance. The multivariate analysis did not reveal approximal cleaning habits to be significant, probably due to their strong connection to gender and toothbrushing habits. In the 1983 sample, no significant explanatory variables were found. It was concluded from this data that it is important not only to renew but also to direct preventive guidelines more towards young adults who have no previous extensive experience of oral disease so that they will not be excluded from dental care and their dental health thereby jeopardised. In addition to preventive programmes aimed at the population as a whole, individual programmes based on risk targeting are also necessary to reduce the number of people developing dental disease and to increase the quality of dental care.     

Prevalence and distribution of gingivitis, periodontitis and missing teeth in adolescents and adults according to GPM/T index

Abstract The purpose of the present study was to determine the distribution and the prevalence of periodontal disease in adolescents and adults using the WHO method TRS 621 and to propose a method of presenting the results by a simple index system. On the basis of a medium term longitudinal 5-yr project 1048 subjects were examined in age group 1 (15–19 yr) and 425 subjects in age group 2 (35–44 yr). Each subject had a full mouth examination for the presence of supra-or subgingival calculus, pocketing, bleeding and recession and the PI (Russell ). These epidemiologic data were characterized by the ratio Gingivitis: Periodontitis: Missing teeth by using solely the recordings for bleeding, pockets and missing teeth. The mean GPM index in Group 1 was 15.4:0.6:0.8. The mean GPM index in Group 2 was 12.0:4.6:7.7. The Periodontal Index is more subjective than the TRS 621 method. Full mouth recording is required for the suggested GPM/T index analogous to the DMFT index. This new scoring ratio makes it possible to present data of the progression rate of periodontal disease by the increment of tooth related P/T and M/T. Both indices with the common M-value (Missing) might be used for longitudinal programs of control and prevention of periodontal disease and dental caries.     

Longitudinal study of dental caries in individuals in Jönköping, Sweden, aged 15 years in 1973 and 20 years in 1978

The aim of this investigation was to study caries development between the ages of 15 and 20 yr in the same individuals. Data concerning 100 adolescents constituted the basic material. Eighty subjects could be re-examined 5 yr after the first examination. The mean number of teeth per subject was 27.1 both in 1973 and in 1978. Four subjects (4%) in 1973 and three subjects (2.4%) in 1978 showed no decayed and/or filled proximal tooth surfaces. The prevalence of intact tooth regions was higher in the mandible than in the maxilla. Only one of the 73 subjects who were free from caries in the mandibular incisor/canine region at the basic examination developed new carious lesions in this region during the next 5-yr period. Analysis of the frequency distribution of the different caries diagnostic groups revealed that 32 subjects (40%) showed no change during the 5-yr period while 47 (58.7%) now belonged to a higher caries prevalence group. 3538 (80.7%) proximal surfaces were diagnosed as intact at the basic examination. The number of intact surfaces 5 yr later was 3107 (70.9%). In individuals with low and high numbers of decayed and/or filled surfaces, respectively, there was a tendency towards a more pronounced individual caries progression in the group that showed the highest caries prevalence at the basic examination than in the group showing a low caries prevalence.     

Periodontal treatment need of the Finnish population aged 30 years and over

A representative sample (n = 8000) was drawn from the population aged 30 years and over, registered as living in Finland. Periodontal disease status was recorded according to the modified Periodontal Treatment Need System (PTNS). Plaque retentions were examined separately. Of the subjects with four or more teeth 3.4% had a healthy periodontal status, while 10.2% of the jaw quadrants were healthy. Plaque retentions were found in 96.6% of the subjects and 90.9% of the jaw segments. Periodontal treatment need was calculated in three ways and was 195 +/- 111 (S.D.) min when the calculation was based on WHO recommendations (1978). Number of teeth, age, sex, caries and filling scores, and education explained about 30% of the treatment need when tested by multiple linear regression analysis.     

Changes in periodontal disease indicators in 35-year-old Oslo citizens from 1973 to 1984

Periodontal disease indicators were evaluated according to the periodontal treatment need system (PTNS) in random samples of 35-year-old citizens of Oslo in 1973 and 1984. The study indicated that although periodontal disease was a common finding in both samples, there was a significant reduction in score C (indicating need for complex periodontal treatment) in 1984 compared to 1973. Whereas 37.9% of the subjects showed inflamed pockets deeper than 5 mm (score C) in 1973, only 22.9% scored C in 1984 (non-Caucasians excluded). This reduction was most pronounced in females. The mean number of C-quadrants in subjects needing complex periodontal treatment was also reduced from 2.0 in 1973 to 1.7 in 1984. Further analyses of the 1984 sample showed that the mean number of C-quadrants was significantly lower in subjects with low OHI-S scores and in regular dental visitors, whereas sex, years at school, toothbrushing frequency, interdental cleaning habits, previous periodontal therapy, self-experienced need for treatment, health attitude or smoking habits, did not seem to influence the prevalence of score C.     

Prevalence and severity of periodontal disease in patients with inflammatory bowel disease

Previous reports have demonstrated that oral mucosa and periodontal lesions occur in patients suffering from inflammatory bowel disease (Crohn's disease [CD] and ulcerative colitis [UC]). It is unknown whether periodontal disease is an occasional or regular finding in these patients. The purpose of this study was to assess the prevalence and severity of periodontal disease in patients with inflammatory bowel disease (IBD). The periodontal status of 107 consecutive patients seeking treatment for inflammatory bowel disease was assessed. Examination of the mid- and mesiobuccal aspects of one quadrant on one jaw and the contralateral quadrant of the opposite jaw revealed the 93.5% of the CD patients and 95.1% of UC patients had at least one site with probing attachment loss of 2 mm or greater, and a mean probing attachment loss 1.4 +/- 0.9 mm and 1.5 +/- 1.0 mm, respectively. We found that 28.3% of CD patients and 29.5% of UC patients possessed at least 1 site with a pocket probing depth of 4 mm or greater; the mean pocket probing depth in these patients was 2.4 +/- 0.2 mm and 2.3 +/- 0.2 mm, respectively. Compared with the assessment of Oral Health of United States Adults, IBD patients revealed a 11.9% higher prevalence (P less than or equal to 0.01) but 0.6 mm lower severity (P less than or equal to 0.01) of periodontal disease. The magnitudes of these differences suggest no clinical implications for the management of periodontal disease in IBD subjects.     

江苏省12～74岁自然人群牙周健康状况流行病学抽样调查

目的了解江苏省12~74岁自然人群牙周健康流行状况,为开展口腔预防保健提供基线资料。方法参考世界卫生组织(WHO)《口腔健康调查基本方法》(第4版)调查方法,采用多阶段、分层、等容量、随机抽样的方法,调查江苏省12岁、35~44岁和65~74岁3个年龄组的城乡居民2373人,其中城市1186人,农村1187人。结果①城乡居民牙周健康的检出率和区段数仅为8.05%和1.62;牙龈出血检出率和区段数为61.27%和1.50;牙结石检出率和区段数为84.45%和3.64;浅牙周袋检出率和区段数为32.07%和0.56;深牙周袋检出率和区段数为7.46%和0.10。②农村居民的口腔健康状况比城市居民差。③中老年组牙周袋检出率和区段数随年龄增长而增加。④3个年龄组相应指标的检出率和平均区段数均高于全国第2次口腔流行病调查的结果。结论牙周病是江苏省居民常见病、多发病,牙结石是居民口腔卫生面临的一个重要问题。因此,应加强口腔预防保健工作,开展社区口腔卫生服务,使牙周病也能做到早发现、早治疗。     

Experimental gingivitis in relation to susceptibility to periodontal disease

The aim of the present study was to investigate the rate of development of experimentally-induced gingival inflammation in relation to the susceptibility to periodontal disease. By selection according to age, a younger (25-39 years) and an older (45-54 years) age group, with a comparable reduced but healthy periodontium, was selected. This equal amount of periodontal breakdown may suggest that the younger age group represented individuals with a relatively higher degree of susceptibility to periodontal disease. At the start of the experiment, each patient was instructed to abstain from oral hygiene procedures in 1 quadrant of the mouth for a period of 18 days. Results showed that all subjects developed signs of gingival inflammation. Regarding the development of redness and swelling, no differences could be assessed between the 2 age groups. However, analysis of the bleeding scores revealed that bleeding on probing developed more rapidly in the younger age group. It was concluded that those patients who have suffered from a more rapid form of periodontal disease also develop inflammation, in terms of bleeding on probing, more rapidly.     

A new approach to investigating associations in periodontal disease data

This paper presents a method for the analysis of data originating from studies of destructive periodontal disease. The proposed method is an extension of the Mantel-Haenszel technique for the analysis of case-control studies and allows for expression of the site-specificity of destructive periodontal disease while maintaining the individual as the unit of analysis. Using data originating from a cross-sectional study of periodontal breakdown and oral hygiene parameters in a random sample of adult rural Kenyans, the proposed method is illustrated and the results compared with results obtained when two alternative analytical methods are used. The results demonstrate that the choice of analytical strategy may have profound implications for the conclusions to be drawn. Depending on the strategy chosen, one may draw conclusions which are qualitatively different and the present study indicates that the direction of these differences is not predictable.     

Hibitane in periodontal disease

Abstract It is generally accepted that gingivitis and periodontal disease can be prevented by means of an effective daily plaque control- Also in the treatment of periodontitis plaque control seems to be essential. The plaque-inhibiting capacity of Hibitane is well documented, and the ability of the agent to prevent gingivitis for a relatively short time has been shown. Thus Hibitane is a valuable drug in dentistry in cases when conventional plaque control is difficult or impossible for a limited period of time. The longterm effect of the drug is less known in humans. However, a few studies in selected populations indicate that the effect is preserved after continuous use for several years. Established destructive periodontitis with pocket formation and subgingival plaque seems unaffected by chlorhexidine, but healthy gingival conditions may probably be maintained by two daily applications of the agent. The indications for long-term use of Hibitane in the mouth are still not satisfactorily clarified. Such use must be regarded and controlled as experiments. Although systemic side effects seem to be rare, some embarrassing local adverse effects have been frequently reported. The staining of teeth and fillings constitutes a serious obstacle to a more generalized use of the agent in dental practice. Several modes of application of Hibitane in the mouth have been suggested. However, the pharmacodynamic properties of chlorhexidine as a plaque-inhibitor are dependent on a series of complicated chemical reactions and may in several ways be jeopardized by components of a vehicle. Therefore, reliable clinical investigations proving the effect of commercial products containing Hibitane are indispensable before advocating their use.     

Periodontal disease and oral hygiene in Israeli youth (14–17 years of age)

abstract The purpose of the present study was to obtain current information regarding periodontal disease, and oral hygiene status. The survey was conducted in Israel among 9th–12th grade students, 14–17 years of age. A total of 1,320 schoolchildren were examined. During the examination only periodontal status and oral hygiene were checked. Periodontal status was recorded according to Russell's Periodontal Index (PI). Oral cleanliness was assessed according to Greene & Vermillion's Simplified Oral Hygiene Index (OHI-S). The mean PI found was 0.22. The results indicated an increase in the mean PI with age. No difference was found in average PI values between girls and boys. On the other hand, significantly lower mean OHI-S values were recorded for girls as compared with boys in the total study population and within the different age groups. Mean OHI-S decreased with age, indicating improvement.     

Dental caries and periodontal disease in Fiji

A national oral survey was conducted in Fiji in 1985/86. The results showed that the prevalence of caries was generally low and most commonly affected pit and fissure surfaces. Comparisons with previous surveys in 1948 and 1965 showed that the prevalence had fallen in primary teeth but remained relatively constant in permanent teeth. There were significant variations in prevalence between residential locations but not between ethnic groups. Periodontal disease was found to be a major public health problem. Except for the percentage of young children with caries-free dentitions, the current status of oral health in Fiji was generally better than that proposed in the WHO goals for the year 2000. The training of dental hygienists to help in the prevention of both dental caries and periodontal disease is discussed.     

Validity of CPITN's assumptions of hierachical occurrence of periodontal conditions in a Kenyan population aged 15–65 years

Abstract – In order to study the validity of the hierachical principle of the CPITN we used data originating in a cross-sectional study of periodontal disease in a random sample comprising 1131 Kenyans aged 15-65 yr to determine, for each tooth present in each individual, the absence or presence of gingival bleeding, of dental calculus, of a pocket of 4–5 mm or a pocket of 6+ mm, such that each tooth had a separate recording for bleeding, calculus, pocket 4–5 mm and pocket 6+ mm. According to the hierachical principle of CPITN a tooth with pockets as the most severe finding is assumed positive also for calculus and bleeding, and a tooth with calculus as the most severe finding is assumed positive also for bleeding. Our analysis showed that calculus as the most severe finding of a tooth overestimates the occurrence of bleeding by up to 18%, depending on age of the individuals and the set of teeth examined. Pockets as the most severe finding in a tooth overestimates the occurrence of bleeding by up to 13%, and overestimates calculus by up to 54%, most pronounced in the younger age groups. The effect of these over estimations on prevalence and severity estimates was the most pronounced for the severity measures, particularly regarding the severity of bleeding, whereas prevalence estimates remained relatively unaffected. Undoubtedly, this result should be seen in the light of a very high prevalence and severity of both bleeding and calculus in this population.     

Effects of oral hygiene on periodontal tissues in a town in Yugoslavia

Abstract We examined 1316 pupils, average age 16.6 years, in a small town in Serbia. The purpose of this study was to find out the effects of the oral hygiene on the condition of the periodontal tissues and the frequency of gingivitis and periodontal disease and their severity in this age group. The presence and quantity of dental plaque were registered according to the Silness & Löe Plaque Index. The amount of dental calculus was determined according to the Greene & Vermillion method. The condition of periodontal tissues was evaluated by Ramfjord's method. It was found that only 5.3% of the examined pupils had a clinically healthy periodontium. Gingivitis was discovered in 60.6%, and periodontal disease (with periodontal pockets) in 34.1% of the examined pupils. The average PDI was 1.8. We revealed great quantities of soil and hard deposits on the teeth of examined pupils. The average Plaque Index was very high (1.9).