Periodontal status and treatment needs among regular dental patients

A survey of periodontal status and treatment needs among dental patients was performed using the CPITN criteria, with the worst score per sextant being recorded, based on examination of all surfaces of all teeth. Regularly attending patients (n = 1092) from 36 general dental practices in two North Carolina counties were examined. The most frequently found worst conditions-per-patient across all ages were the presence of calculus (35 per cent) and the presence of 4-5 mm pockets (35 per cent). The most common worst condition-per-sextant was bleeding (32 per cent) followed by calculus (28 per cent). Less than a fifth of all sextants exhibited pocketing, although half of the patients had at least a 4-5 mm pocket. The mean amount of treatment time required for these conditions was 33 minutes, reflecting the general absence of the need for complex periodontal treatment.     

Dental health status and treatment needs of elderly residents of Edmonton, Alberta

The oral health of 140 independent elderly volunteers, selected from different sections of Edmonton, Alberta, was assessed in conjunction with their nutritional and medical status, in an attempt to evaluate the dental needs of this population. Dental caries was assessed using WHO standards and the CPITN was used in assessing periodontal and gingival health needs. The mean age of the participants was 70.9 +/- 2.6 years. The average time since they had last seen a dentist was 3.0 +/- 6.2 years. Twenty-six percent of the group were edentulous and wore full dentures. An evaluation of denture hygiene and retention showed that 53 per cent of all maxillary and 57 per cent of all mandibular appliances exhibited poor hygiene; 33 per cent and 54 per cent, respectively, had problems with retention and/or occlusion. Only 12 per cent of the group exhibited any sort of mucosal pathology, all of which was related to ill fitting dentures. The total population had a mean of 15.0 +/- 11.1 teeth, only 0.5 of these were decayed, while 8.9 were restored. CPITN scores taken from a total of 511 sextants with standing teeth showed that 16 per cent of the group exhibited bleeding upon probing, 29 per cent had calculus, 13 per cent exhibited pocketing, while 3.6 per cent had deep pockets. Sixty-seven per cent of the population required dental treatment, none of whom needed emergency intervention. Over 49 per cent of the dentate population could benefit from prophylaxis; 16 per cent required more definitive periodontal treatment. Forty-five per cent of the denture population required treatment.     

CPITN assessments in institutionalised elderly people in Kitakyushu, Japan

A CPITN survey was conducted on 1958 institutionalised elderly people aged 59 years and older at 29 of the 30 public and private institutions in the city of Kitakyushu, Japan. About 60 per cent of the sample was edentulous, and the prevalence of periodontal conditions was high. The percentages of dentate subjects with healthy gingivae, bleeding on probing, calculus, shallow pockets, and deep pockets were 3, 4, 32, 52, and 9 per cent respectively. Half the sextants in the dentate subjects were scored as excluded (less than two teeth), indicating that many teeth were missing. Only very few sextants were healthy. These findings indicate the importance of preventive programmes for periodontal diseases in the younger generations, because (a) dental care for the elderly population becomes more difficult with increasing age and (b) periodontal care, if it is available at all, is provided too late for most people.     

Relationship between CPITN and oral health behaviour in Japanese adults

Many studies on toothbrushing have concentrated on clinically diagnosing plaque and measuring periodontal status as indicators of oral health behaviour. From a behavioural point of view, however, the more important objective is the health behaviour itself. To investigate the relationship of oral health behaviour to periodontal status, 517 urban employees in Japan (249 men and 268 women aged 20–59 years) responded to a 20-item dental health behaviour questionnaire, entitled the HU-DBI, and had their periodontal conditions examined using the CPITN. Only 1 per cent were found with a healthy periodontium (Code 0), and 9 per cent had bleeding on probing (Code 1). Calculus (Code 2) was the most prevalent condition with 51 per cent of subjects having this code as the worst condition, followed by shallow pockets (Code 3) in 30 per cent, and deep pockets (Code 4) in 9 per cent of the sample. The mean HU-DBI score was 4.2 (out of 12). Females had somewhat higher scores than males (4.4 vs. 4.0, p<0.05). CPITN had a negative relationship with the HU-DBI (r=-0.26, p<0.001), and a positive relationship with age (r = 0.40, p<0.001). Similar relationships were observed in each gender. These data demonstrate the relationship of age with periodontal status, and periodontal status with oral health behaviour. A two-dimensional matrix of HU-DBI score by CPITN may provide a simple and effective means of identifying low and high risk individuals.     

Periodontal conditions in adolescents, 15–19 years of age: an overview ot CPITN data in the WHO Global Oral Data Bank

Results of 61 CPITN surveys in 39 countries for the age group 15-19 yr, stored in the WHO Global Oral Data Bank as of 1 July 1987, are assembled in an overview showing percentages of persons according to the highest score for each person and the mean numbers of sextants affected per person. The most frequently observed condition was score 2 (calculus with or without bleeding), although some shallow pocketing of 4 or 5 mm was present in most populations surveyed. It should thus be emphasized that the major thrust of activities in periodontal care should be in health promotion and education, leading to improved oral hygiene.     

Periodontal status by CPITN, and associated variables in an Israeli permanent force military population

AIMS: The objectives were to determine periodontal treatment needs using the CPITN index, of Israeli permanent force military personnel. METHODS: The study population consisted of 1300 military personnel aged 25-44 years (mean age 33.8 +/- 5.4), who attended obligatory routine medical and dental examinations. Clinical examinations were conducted by 3 calibrated examiners, employing flat dental mirrors, the specially designed WHO periodontal probes (FDI probes) and following CPITN criteria. The frequency distributions were studied with regard to age groups, gender and education, as well as differences in the severity of the disease. Also, the mean number of sextants affected per person by age was assessed. RESULTS: Only 1.19% of the subjects demonstrated healthy periodontal tissue. Shallow pockets were similarly found among all age groups, and the number of persons with deep pockets increased with age. Deep pockets were found almost 3 x more among males (18.66%) in comparison with females (6.19%). Persons with higher education (> 12 years), had less deep pockets and bleeding than individuals with less than 12 years of education (p<0.05). CONCLUSIONS: Compared with data from other countries reported by the WHO, this periodontal status indicates a relatively high level of treatment needs. This survey provides a substantial contribution to the national oral health data bank concerning the adult working population in Israel.     

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.     

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.     

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.     

Use of CPITN cross-tabulations--a research perspective

In earlier years, studies on the epidemiology of periodontal disease were often reported in the form of mean scores for the population studied. Use of the WHO recommended Community Periodontal Index of Treatment Needs (CPITN) has given important additional information, particularly about the distribution of indicators of current periodontal disease within various age groups of the population. In the analysis of survey data, the use of CPITN cross-tabulations has been found particularly promising for the assessment of both preventive and therapeutic needs. For example, in Finnish schoolchildren the proportion of subjects with two or more sextants scoring Code 2 for calculus increased from 0 per cent at age 7 to 5 per cent at age 12 and 9 per cent at age 17 years. In the same population, 0 per cent at 7, 1 per cent at 12, and 4 per cent at 17 years of age had one or more pockets measuring more than 3 mm. In another population, comprising dentate adults from rural Finland, the prevalence of Code 4 for 6 mm or deeper pockets increased from 1 per cent at age 25 to 6 per cent at age 35, 18 per cent at age 50, and 27 per cent at 65 years of age. An important additional observation was that a total of 58 per cent of those who had one or more Code 4's, had their advanced periodontal disease confined to only one sextant. The latter finding may prove useful when deciding between partial and full mouth examinations in future epidemiological studies.     

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.     

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.     

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.     

Relative influence of calculus and overhangs of fillings on the frequency of score 2 of the CPITN

Periodontal treatment needs of 895 dentate subjects aged 25, 35, 50 and 65 yr were studied according to the Community Periodontal Index of Treatment Needs (CPITN). The relative influence of calculus and overhanging margins of restorations on the need for professional debridement of shallow (less than or equal to 3 mm) pockets was calculated. The mean number of sextants per person scoring CPITN Code 2 decreased from 2.6 in the 25-yr group to 1.1 in the 65-yr group. Overhangs of fillings alone were detected in 0.8 sextants of the 25-yr-olds and in 0.1 sextants of the 65-yr-olds. The mean number of sextants containing calculus with or without overhangs decreased from 1.8 in the 25-yr group to 1.0 in the 65-yr group. The relative influence of calculus was higher in the aged than in the young population. The recording of overhangs is important for accurate assessment of periodontal treatment needs in populations with a high caries experience.     

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 needs in 12 and 15 to 19-year-old school children in the Caribbean island of Antigua, 1990

A national survey was undertaken in 1990 to investigate the periodontal treatment needs in 12 and 15 to 19-year-olds residing in urban and rural areas of Antigua. Using the CPITN procedure, examination of 246 12 year-old children and 456 adolescents (15–19 years) revealed that the CPITN scores of healthy, gingival bleeding, calculus, 4 or 5 mm and ≥6 mm periodontal pockets were distributed similarly in urban and rural areas. Calculus was the most commonly recorded score, with a prevalence of 46% in 12-year-olds and 56% in 15–19 year-olds. 4 or 5 mm pockets were found in 14% of adolescents, affecting on average less than one sextant per subject, but deep pockets were uncommon, 26% of 12-year-olds and 14% of adolescents had periodontally healthy mouths. Scaling and oral hygiene instruction were the predominant treatment needs in both age groups, but the requirement for complex periodontal care in adolescents was low – 3% only.     

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%).     

Prevalence and severity of periodontal diseases in Saudi Arabian schoolchildren aged 6, 9 and 12 years

A random sample of 2321 school children aged 6, 9 and 12 years was examined in the Riyadh Central Province for periodontal conditions using the CPITN and the epidemiological methods established by the World Health Organisation. Results indicated that 59 per cent of 6-year-old children had a healthy periodontal state, and 40 per cent had bleeding. Among 9-year-old children 42.9 per cent were healthy, 48.7 per cent had bleeding and 7.8 per cent calculus. The percentage with healthy periodontal conditions fell to 32 per cent in 12-year-old children; 52 per cent had bleeding and 16 per cent had calculus. The differences between sexes were significant at all age groups (6, P less than 0.05; 9, P less than 0.01; 12, P less than 0.001). It is concluded that oral hygiene therapeutic measures (professional and self-care), and dental health education are needed by the school age population.     

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.     

Profiles of periodontal conditions in adults measured by CPITN.

Results of almost 100 CPITN surveys in more than 50 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 August 1990, are assembled. They are presented in the form of graphs showing the percentages of persons according to the highest score per person and arranged by country according to WHO regions. It is hoped that these overviews provide a frame of reference for the evaluation of periodontal conditions in populations and population subgroups. Calculus and shallow pocketing were the most frequently observed conditions. With a few exceptions, the percentages of persons and the mean number of sextants per person with deep pockets were small to very small. The assumed differences between industrialized and non-industrialized countries with regard to periodontal health were not reflected in the survey data examined. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before the age of 50. For the large majority in most of the populations observed, the progress of periodontal diseases seems to be compatible with the retention of a natural dentition into older age. Nevertheless, the periodontal problem is of considerable magnitude and importance, as 5-20 per cent of populations are affected by a serious, irreversible condition at the age of 40, which is a high percentage compared with almost every other disease that afflicts mankind.