Periodontal status of a subject sample of Yemen

Abstract From August to October 1991, the periodontal status of 1001 Yemenis representing the age groups 12-14, 15-19, 20-24 and 35-44 years was recorded and evaluated with preference to the CPITN, the calculus index and clinical attachment levels. The impact of chewing khat, the leaves of a cultivated, alkaloid shrub, and of using the traditional miswak chewing stick for oral hygiene purposes were investigated. The results show that 6.9% of the juvenile probands (15-19 years) had healthy periodontal tissue (CPITN 0). whereas bleeding on probing and calculus (CPITN 1+2) were registered in 86.2%. In the 35-44 year age group. 1.7% were periodontally healthy, whereas 84.5% displayed plaque retention or shallow pocketing (CPITN 2-3) and 12.5% deep pocketing (CPITN 4). The treatment needs in all age groups are confined primarily to calculus removal and instruction in oral hygiene. The clinical attachment level and the calculus index revealed age-related attachment loss and calculus formation, primarily among male probands. The higher khat consumption among the male population is reflected in its detrimental effect on the periodontal tissue, especially among younger probands. Oral hygiene aids have also an influence on periodontal status, with a toothbrush proving more efficient than the miswak. WHO efforts directed towards prophylactic programs need to be intensified but can be staffed by dental hygienists.     

Assessment of periodontal status in dental fluorosis subjects using community periodontal index of treatment needs.

BACKGROUND: Periodontitis is multifactorial in nature. The various determinants of periodontal disease are age, sex, race, socioeconomic status and risk factors including tobacco usage and oral hygiene status. However, there is inconsistent epidemiological data on the periodontal status of subjects living in high-fluoride areas. The aim of the study was to investigate the effect of dental fluorosis on the periodontal status using community periodontal index of treatment needs (CPITN), as a clinical study. The purpose of this study is to determine the periodontal status using CPITN index in a population aged between 15 and 74 years residing in the high fluoride areas of Davangere district. The possible reasons for the susceptibility of this population to periodontal disease are discussed. MATERIALS AND METHODS: 1029 subjects, aged between 15 and 74 years suffering from dental fluorosis were assessed for their periodontal status. Clinical parameters recorded were OHI-S to assess the oral hygiene status, Jackson's fluorosis index to assess the degree of fluorosis and CPITN index to assess the periodontal status where treatment need was excluded. RESULTS: Gingivitis and periodontitis were more common in females (65.9% and 32.8%,respectively) than in males (75.1% and 24.2%, respectively). Periodontitis was significantly more common in females. As the age advanced from 15 to 55 years and above, gingivitis reduced from 81.0 to 42.9% and periodontitis increased steadily from 18.0 to 57.1%, which was significant. Periodontitis was high in subjects with poor oral hygiene (81.3%), compared to those with good oral hygiene (14.5%), which was significant. As the degree of fluorosis increased, severity of gingivitis reduced and periodontitis increased, i.e, with A degree fluorosis, gingivitis was 89.4% and periodontitis 8.5%, but with F degree fluorosis the former was 64% and the latter 35.8%, which was statistically significant. CONCLUSION: The results suggest that there is a strong association of occurrence of periodontal disease in high-fluoride areas. The role of plaque is well understood in contrast to the effect of fluorides on periodontal tissues. It goes a long way to reason out fluoride as an important etiological agent in periodontal disease.     

Multivariate analysis of oral hygiene data from a representative sample

BACKGROUND: This analysis was based on an oral health survey with dental examination and interview by questionnaire. METHOD: The data set comprised a representative random sample of the over 14-year-old residents of the German Federal State of Saxony (n=714), in which a multivariate logistic regression analysis was conducted. The dependent variable was the debris index (DI) score of the oral hygiene index scoring system. The subjects were split into 2 groups by dividing DI scores into tertiles: those with acceptable oral hygiene (1st tertile, DI 0.00< or =1.20) and unacceptable oral hygiene (2nd and 3rd tertile, DI>1.20). The most important explanatory variable was the community periodontal index of treatment need (CPITN). RESULTS: The higher the CPITN score, the lower the probability of acceptable oral hygiene. In relation to the reference category score 0, higher CPITN scores were associated with acceptable oral hygiene, with an odds ratio 0.05 (95% confidence interval (CI)=0.01-0.23) for CPITN score 1, and an odds ratio 0.02 (95% CI: 0.01-0.08) for score 4. Further significant variables were: self-evaluation of tooth condition, gender, and the number of missing teeth.     

Influence of orthodontic anomalies on periodontal condition]

INTRODUCTION: Three main reasons are routinely cited to justify the provision of orthodontic treatment: improvement of facial and dental aesthetics and of dental health and function. However, association between malocclusions and periodontal condition is still controversial. The aim of the present study was to further investigate the correlation between certain orthodontic anomalies and periodontal condition. MATERIALS AND METHOD: One hundred and one subjects were included in this study. Information regarding oral hygiene habits and accessibility to professional oral health care were obtained from each subject. Malocclusions were assessed with the Indice of Orthodontc Treatment Need (IOTN) and the Index of Complexity, Outcome and Need (ICON) and periodontal with the Community Periodontal Index for Treatment Need (CPITN). Spearman Rank correlation order was used to test for any association between malocclusions and periodontal condition. Significance was set at the 5% level. RESULTS: Contact point displacements (malpositions) are positively and significantly correlated to CPITN in the mandibular arch. There was also significant negative correlation between spacing and CPITN in the maxilla. Openbite and overjet assessed by IOTN have a significant positive correlation with the periodontal condition as assessed by the CPITN. In contrast no correlation was found with dental crossbite (IOTN and ICON). At last, there was significant correlation between overbite and periodontal condition. CONCLUSION: Significant correlations were found between malocclusions and periodontal condition. Within the limitation of this study one can suggest that malocclusions are risk marker for periodontal diseases. However, this study by virtue of its protocol cannot allow us to makeany inference about a cause/effect relationship between malocclusions and periodontal condition.     

Assessment of periodontal treatment needs among adults with diabetes in Finland

OBJECTIVES: People with diabetes have a high risk for periodontal disease, which can be considered one of the complications of diabetes. We evaluated periodontal treatment needs using the Community Periodontal Index of Treatment Needs (CPITN) in relation to diabetes-related factors and oral hygiene. DESIGN: The sample consisted of 120 dentate diabetics, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic. The nurses, who interviewed the patients, collected data on duration and type of diabetes, complications, and HbA1c level. Clinical periodontal examination included identification of visible plaque, the presence of calculus and use of the CPITN. RESULTS: The CPITN score 3 was the most prevalent. According to the logistic regression model, poor metabolic control was significantly related to pathologic pockets. No significant association was found between diabetes-related factors and the highest individual CPITN score of 4, which was, in turn, significantly associated with extensive calculus. CONCLUSIONS: Excessive periodontal treatment needs found, indicate that current dental care may be insufficient in adults with diabetes. Oral health among high-risk groups, especially those with poor metabolic control, should be promoted by collaboration between dental and health care professionals involved in diabetes care.     

Prevalence and determinants of periodontal disease in Portuguese adults: results from a multifactorial approach

The purpose of the present investigation was to study prevalence of periodontal disease among 30 to 39-years-old from Oporto in the north of Portugal. In addition, an attempt was made to elucidate possible periodontal disease determinants in this population. A random sample consisting of a total of 322 individuals was drawn based on electoral lists. The attendance rate was 61%. The CPITN index was used and the results indicate a high prevalence of periodontal disease and a substantial need for periodontal treatment in this population, with 41% of the individuals investigated having one or more sites with a CPITN score 4 (pockets deeper than 5.5 mm). Dental visiting habits, gender (lower CPITN scores for females) and oral hygiene were the determinants most significantly associated with variation in CPITN scores.     

Prevalence and determinants of periodontal disease in Portuguese adults: results from a multifactorial approach

The purpose of the present investigation was to study prevalence of periodontal disease among 30 to 39-years-old from Oporto in the north of Portugal. In addition, an attempt was made to elucidate possible periodontal disease determinants in this population. A random sample consisting of a total of 322 individuals was drawn based on electoral lists. The attendance rate was 61%. The CPITN index was used and the results indicate a high prevalence of periodontal disease and a substantial need for periodontal treatment in this population, with 41% of the individuals investigated having one or more sites with a CPITN score 4 (pockets deeper than 5.5 mm). Dental visiting habits, gender (lower CPITN scores for females) and oral hygiene were the determinants most significantly associated with variation in CPITN scores.     

Periodontal treatment needs in a native island community in Colombia determined with CPITN

AIMS: To identify the prevalence and different degrees of periodontal disease in an isolated community (Isla Grande, Colombia) with no dental services and low educational level with the use of CPITN, and to establish periodontal treatment needs in different age groups. RESULTS: Of 116 people examined, 0.9% were in periodontal health (CPITN value 0), 18.1% had gingival bleeding (CPITN value 1), 51.7% had supra or subgingival calculus (CPITN value 2), 18.1% presented pockets 3.5-5.0 mm deep (CPITN value 3), and 11.2% had pathological pockets of 5.5mm or deeper (CPITN value 4). No clear differences were observed between sexes. CONCLUSIONS: This study shows that 81% of the sample has some type of periodontal treatment need, with 69.8% of them requiring periodontal treatment that may be supplied by a hygienist and 11.2% requiring specialised treatment. Implementation of oral health education and oral prevention programmes was recommended to the authorities for this community.     

The effect of smoking on periodontal conditions assessed by CPITN.

One hundred eighty subjects were examined to assess the effect of smoking on periodontal conditions by community periodontal index for treatment needs (CPITN). All subjects were interviewed regarding their oral hygiene habits. Data were entered to the computer and statistical analysis system (SAS) was utilised. Results showed that the frequency of smokers is 31% where 25.9% of this were male. Smokers use toothbrush in performing their oral hygiene more than non-smokers. Results also showed that periodontal conditions as measured by CPITN were not significantly different between smokers and non-smokers. However, further studies with more sensitive periodontal indices are recommended in the future to assess the differences between both groups.     

Dental health status of junior high school students in the suburbs of Chiba city

The Population of 12-15 years is a key age group for oral health because the permanent dentition and periodontal tissues are almost complete at this stage. The purpose of this study was to evaluate oral health status and to develop an effective school dental health program for junior high schools students. The survey was performed on 527 persons aged 12-13 at 2 junior high schools in the suburbs of Chiba city. Periodontal disease was evaluated on the basis of the CPITN, and analyzed for severity and region of periodontal disease. Gingivitis was examined with PMA index, using color photo slides taken of anterior dentition at the time of inspection. At the same time, caries experience and oral hygiene index were also estimated. The results were as follows: (1) The mean DMFT was 3.89. Caries prevalence in females was higher than males. Ratio of treated teeth rate was 77.03%; that of untreated teeth rate was 22.65%. Females revealed less treatment for caries than males. Oral hygiene index showed significant difference between males and females. Labial and buccal parts of the maxillary and molar region on the mandibular showed remarkable plaque deposition. Calculus accumulation in this population was greatest on the lower incisor. (2) The mean PMA index was 7.36. Gingivitis was highly prevalent in both sexes, although it was more severe in males. There was correlations between PMA index and OHI. (3) From the results of CPITN, 10.6% of the subjects showed no signs of periodontal disease (Code 0), and 5.7% exhibited gingival bleeding (Code 1).(ABSTRACT TRUNCATED AT 250 WORDS)     

The periodontal status of 13-year-old children in western Canada using the CPITN index

A large study of the dental health of children in the Canadian province of Alberta was undertaken in 1985. A ten per cent sample of 13-year old children (3117) was selected. This study reports on the gingival status of the children using the community periodontal index of treatment needs (CPITN). The findings show that the children have few periodontal problems and that the main treatment needs are oral prophylaxis and improvement in personal oral hygiene. The World Health Organisation guideline for the year 2000 in respect of the long-term goals for periodontal health is met in this Canadian population.     

The relationship between periodontal disease and blood glucose level among type II diabetic patients

The aim of this study was to determine the relationship between periodontal disease and the blood glucose level among type II non-insulin dependent diabetic mellitus (NIDDM) subjects. Forty subjects, 20 in each group, of healthy and diabetic subjects, ages ranged 20-70 years, were examined at King Saud University, College of Dentistry. Clinical examination included frequency of oral hygiene practices, periodontal status by using the Community Periodontal Index of Treatment Needs (CPITN), fasting blood glucose level (FBGL), and random blood glucose level (RBGL). Unstandardized orthopantomograms (OPGs) were taken for radiographic findings. The number of missing teeth (tooth loss) was assessed from the radiographs. The results showed that periodontal disease severity was high among diabetic subjects. Diabetic subjects brushed less frequently, and they had a higher blood glucose level than healthy subjects. The mean CPITN score was compared with mean blood glucose level and the severity of periodontal disease. There was a steady increase in blood glucose level with increase in CPITN scores, i.e., CPITN score 13.5 to 19.12 corresponded with 142 mg/dl and 173.2 mg/dl FBGL, and 184.2 and 199.12 mg/dl RBGL among diabetic subjects. The study indicated that diabetic subjects should improve their oral hygiene practices and control of blood glucose levels should be emphasized. Further studies are needed among diabetics and healthy subjects from the general population with better sampling techniques and a larger sample size.     

Periodontal conditions in medically compromised elderly subjects: Assessments of treatment needs

Periodontal conditions were studied in 42 dentate elderly subjects (mean age, 84.1 ± 8.0 years). None of them had received recent dental care or was routinely seen by a dentist. Overall, they had 20.2 ± 7.1 teeth (range, 6–32). The CPITN was used to assess periodontal status. Twenty-nine percent of all sextants were either edentulous or had only one remaining tooth. The overall oral hygiene was poor (Plaque Index, 1.8 ± 0.5) and gingival inflammation severe (Gingival Index, 1.9 ± 0.8). Significant correlations were found between: Gingival and Plaque Indices (r = 0.82, p < 0.001), and pocket depth and Gingival Index (r = 0.38, p < 0.05). Plaque Index was negatively correlated to the number of remaining teeth (r = 0.43, p < 0.050). Age and remaining teeth were negatively correlated (r = 0.38, p < 0.05). Thirty percent of the posterior sextants had a CPITN score of "4," and 75% of the posterior sextants had at least one site with a pocket depth 4 mm. Only 2.9% of all sites demonstrated pocket depth 6 mm and these sites were distributed among 67% of the subjects. The CPITN index was correlated to the mean pocket depth for the various sextants, the correlation varying between r = 0.67, p < 0.001 (upper right posterior) and 0.36, p < 0.05 (upper left posterior) sextants. The total manpower estimated to complete initial therapy for 42 patients was approximately 63 hours by a dentist and 85 hours by a dental hygienist.     

Clinical Correlates of a Lateral‐Flow Immunoassay Oral Risk Indicator

Background: The aim of the present study is to investigate the clinical correlates of a novel lateral‐flow immunoassay with bleeding on probing (BOP), oral hygiene, and periodontal probing depth. This report offers a simple, rapid, and highly sensitive tool that addresses two issues important to periodontists: 1) detecting active periodontitis, and 2) predicting chronic periodontitis. Methods: Seventy‐six of 86 males requiring seminal fluid analysis as part of a separate study were serially recruited into the study. After basic dental and periodontal examination under natural light and with the use of the community periodontal index of treatment needs (CPITN) probe, debris and calculus indices were recorded per participant. Participants were subsequently grouped into “good,” “fair,” and “poor” oral hygiene categories based on a simplified oral hygiene index. BOP was assessed with the ball‐ended tip of the probe, and periodontitis was assessed with pocket probing as well as a lateral flow of neutrophil collagenase‐2 immunoassay, which measures levels of matrix metalloproteinase‐8. Results: Neutrophil collagenase‐2 immunoassay was 96% sensitive for poor oral hygiene, 95% sensitive for chronic periodontitis (defined as at least two sites with periodontal pockets), and 82.6% sensitive for at least two sites with BOP. Conclusion: Neutrophil collagenase‐2 immunoassay had a high sensitivity for at least two sites with BOP and two sites with periodontal pockets but a lower relationship for single‐site pockets and BOP.     

Comparison of periodontal disease in patients with clefts of palate and patients with unilateral clefts of lip, palate, and alveolus.

OBJECTIVE: Long-term health of the stomatognathic system as well as esthetic aspects are the therapeutic goals in patients with orofacial clefts. The aim of this study was to analyze the periodontal condition of patients with cleft palate (CP) and cleft lip, palate, and alveolus (CLP) and to determine the differing degrees and localization of periodontal disease. DESIGN: In 30 patients with unilateral cleft lip, palate, and alveolus and 30 patients with cleft palate (CP), periodontal lesions were identified and classified according to the Community Periodontal Index of Treatment Needs (CPITN) and pathological mobility of teeth was noted. The state of oral hygiene was recorded by the Approximal Plaque Index. RESULTS: In general, poor oral hygiene was found in all patients. Patients with CLP were classified as CPITN code 0 in 0%, codes 1 and 2 in 7%, code 3 in 43%, and code 4 in 50% of cases. Patients with cleft palate showed code 0 in 0%, codes 1 and 2 in 30%, code 3 in 45%, and code 4 in 25% of cases. In this study, periodontal disease was found in patients with cleft palate to a similar extent to that in the general population, whereas patients with cleft lip, palate, and alveolus had a predisposition to deep periodontal destruction of teeth adjacent to the cleft. The registration of pathological mobility of teeth and resulting loss of attachment corresponded to the periodontal disease classification according to the CPITN. CONCLUSION: A critical periodontal situation was found in patients with unilateral cleft lip, palate, and alveolus. In contrast, patients with cleft palate exhibited a similar periodontal situation to that found in the general population, with additional damage that may be attributed to orthodontic treatment.     

Dental anxiety--an epidemiological study on its clinical correlation and effects on oral health

Pronounced dental anxiety could lead to avoidance strategies to evade dental visits. The aim of the present epidemiological study was to investigate the prevalence and related oral disease patterns of dental anxiety in young adult male soldiers. Therefore, the intensity and frequency of dental anxiety are presented and the correlation with oral clinical findings are evaluated. Three hundred seventy-four soldiers who underwent a compulsory dental check-up were randomly assigned to this study. Psychological parameters were collected based on a protocol integrating the Dental Anxiety Scale (DAS) and the Gatchell Fear Scale (GaFS). Patient-based measures included D3,4MF-scores for dental status and the Community Periodontal Index of Treatment Need (CPITN) for periodontal status. Thirty-two individuals (8.6%) showed DAS-scores of 13 or 14 (anxious), while 4.6% had a DAS-score > or = 15 (highly anxious/phobic). Highest DAS-values were measured among patients' aged 19-29 (n = 262). DMFS-values of anxious and less anxious patients showed only minor differences. However, anxious patients had significantly more carious lesions (P < 0.001). CPITN periodontal values showed no significant differences between both groups. 89.2% of less anxious individuals and 79.6% of anxious patients went for regular dental check-ups. Thus, every tenth patient was considered to have high dental anxiety. Anxiety results in avoidance behaviour, which can only be discovered upon compulsory examinations and which is associated with higher caries morbidity and need for oral rehabilitation. As anxiety has a direct influence on oral health, it should be detected and accounted for in a treatment concept integrating dental and cognitive-behavioural therapeutic approaches.     

Periodontal conditions in 65-74 year old adults in France, 1995

In 1995, a study was undertaken in France to assess the periodontal health status of 603 noninstitutionalized elderly subjects aged 65-74 years. Thirty areas were identified in the Rh?ne-Alpes region, with a sampling method based on stratified quotas according to sex, place of residence and socio-economic group (S-EG). The CPITN index was used. The total prevalence of healthy dentate adults (n = 483) was 16.5 per cent, whilst 16.3 per cent of the adults were edentulous. The prevalence of CPITN code 1 + 2 (low) was 50.7. The higher S-EG having fewer codes 1 and 2 (45.8 per cent) than the lower S-EG (49.7 per cent) and the medium S-EG (55.7 per cent). The total prevalence of periodontal disease (code 3 + 4) was 31.5. The prevalence of periodontal disease was lower in adults of medium socio-economic status and was also lower in adults living in urban residences. Overall, 66.9 per cent of the entire population needed oral hygiene instruction, 56.6 per cent scaling and 2.3 per cent complex periodontal treatment.     

Periodontal conditions in Hesse, Federal Republic of Germany, measured by CPITN

The periodontal status and the need for treatment were investigated among 3140 inhabitants of the Federal German state of Hesse, using the CPITN index. The male and female subjects forming the case material were divided into 6 age categories (I up to 19 yr, II 20-24 yr, III 25-29 yr, IV 30-34 yr, V 35-44 yr, VI 45 yr or more). The dentitions of 1.3% of those examined were healthy from the periodontal aspects (CPITN 0). 3.3% of examined persons displayed an increased tendency towards bleeding on probing as the sole pathologic manifestation (CPITN 1); calculus and bleeding on probing (CPITN 2) were recorded in 35.5% of patients. Shallow pocketing (CPITN 3) was observed in 49.3, and deep pocketing (CPITN 4) in 10.6% of the examined subjects. There was a marked increase in scores 3 and 4 among patients from age group V. In addition, the posterior teeth were more susceptible to disease than those in the anterior segments, with slightly higher figures being recorded among female than among male individuals. 98.7% of the patients were in need of periodontal treatment. Application of the PTNS index yielded a treatment requirement of 6841.0 hours for the examined population. 2323 hours of this time were allocated to oral hygiene instruction, 4148 hours to scaling and 370 hours to surgical intervention.     

The influence of microvascular complications caused by diabetes mellitus on the inflammatory pathology of periodontal tissues

The aim of our study was to analyze inflammatory pathology of periodontal tissues in patients with diabetes mellitus, and the relationship of this pathology with other complications caused by diabetes mellitus. In our study, we evaluated 126 people aged 16-53 years (42 males and 84 females) with diabetes mellitus admitted to the Clinic of Endocrinology of the Hospital of Kaunas University of Medicine (HKUM). The condition of periodontal tissues was evaluated according to the World Health organization (WHO) CPITN index. Oral hygiene was evaluated using a simplified oral hygiene index (OHI-S) according to Green-Vermillion. Out of 126 subjects with diabetes mellitus, periodontitis was detected in 96 patients (36 males and 60 females) (CPITN index 2-5). Gingivitis was found in 27 subjects (CPITN index 1). Only 2.4% of the studied patients had healthy periodontal tissues. The study analyzed complications of other organs (neuropathy, and nephropathy and retinopathy) caused by diabetes mellitus. The obtained findings showed that microvascular complications were diagnosed more frequently in the presence of more severe inflammatory pathology of periodontal tissues. Retinopathy was diagnosed in patients with CPITN index 2.8+/-0.1, while patients with CPITN index 1.8+/-0.3 had no retinopathy. Neuropathy was more common among patients whose CPITN index was 2.9+/-0.1, while the condition was absent in cases where the CPITN index was 1.8+/-0.2. Comparable results were yielded by the studies of nephropathies in relation with changes in periodontium. Nephropathy was diagnosed in patients whose CPITN index was 3.0+/-0.1, and was not found in patients with CPITN index 2.1+/-0.2. The generalization of the obtained study data allows for stating that a more detailed analysis of factors causing complications of diabetes mellitus will also allow for a more profound understanding of the etiopathogenetic mechanisms that cause inflammatory pathology of periodontal tissues.     

Trends in periodontal health among 35-year-olds in Oslo, 1973-2003

AIM: The aim of the present study was to describe trends in periodontal health and oral hygiene using data available from four epidemiological studies on 35-year-olds in Oslo performed from 1973 to 2003. MATERIAL AND METHODS: Periodontal status of randomly selected 35-year-olds was assessed clinically and radiographically. Clinical registrations were based on the Community Periodontal Index of Treatment Needs (CPITN) and the Simplified Oral Hygiene Index. In addition, the proportion of individuals with marginal bone loss was assessed using available orthopantomograms. RESULTS: The proportion of persons with CPITN score 4 (one or more pockets > or = 6 mm) decreased from 21.8% in 1984 to 8.1% in 2003. In addition, the mean number of sextants with deep pockets per person was considerably lower in 2003 than previously. The proportion of persons without recorded bone loss increased from 46% in 1973 to 76% in 2003. An improvement in oral hygiene scores was also observed during this period. CONCLUSIONS: The results suggest that periodontal health and oral hygiene have been improving among 35-year-olds in Oslo during the last 30 years.