Assessment of periodontal disease in an adult population survey in Taipei city using CPITN and GPM/T indices

The community periodontal index of treatment needs (CPITN) has been recommended for epidemiological surveys of periodontal status and treatment needs. The prevalence of gingivitis, periodontitis and missing teeth in a study population has been determined using the CPITN and GPM/T (gingivitis: periodontitis: missing teeth) indices. In this study, a survey of periodontal disease was performed among the adult population of Taipei City using the CPITN index. A total of 673 dentated persons (male 339, 50.4%; female 334, 49.6%) were examined and surveyed. Data were then divided into five age groups, 15-19, 20-29, 30-44, 45-64 and 64+. The prevalence of periodontal disease was analyzed using the percentage or sextant from all teeth. Treatment needs were determined by the worst periodontal score per sextant. It was found that about 91% of subjects suffered from various degrees of periodontal disease in at least one tooth. Gingivitis and periodontitis were 86.9% and 33%, respectively. Among them 48.9% had missing teeth. The prevalence of periodontitis and missing teeth increased with age. Most of them involved oral hygiene instruction and scaling. About 11.0% of the subjects needed periodontal surgery. Higher proportions of attachment loss with gingival recession caused by destructive periodontal disease were found in older persons who did not require periodontal surgery. It was concluded that endemic gingivitis and calculus, a moderate prevalence of shallow pockets and a low prevalence of deep pockets were observed among adults in this group in Taipei City and that the CPITN is a practical epidemiological and public health method for screening the periodontal status and treatment needs of a population.     

Periodontal assessment using the Community Periodontal Index of Treatment Needs at Westmead Hospital, Sydney, 1984

The periodontal status and treatment needs were determined for a consecutive sample of 200 subjects 15 years and over who presented at the Assessment and Diagnosis Department at the Westmead Hospital Dental Clinical School. A partial recording of the Community Periodontal Index of Treatment Needs using 10 index teeth for subjects 20 years and over and six index teeth for subjects under 20 years was used.
Periodontal disease prevalence was high (with 98 per cent affected) but in most subjects it was of mild to moderate severity. Advanced periodontal disease (pockets of 6 mm or more) was present in 15 per cent of the sample.
The major treatment requirement in all age groups was for simple periodontal care involving scaling and oral hygiene instruction that could be managed by non-specialist dental resources.     

Periodontal considerations of the removable partial overdenture

1. An overdenture, whether complete or partial, is an excellent mode of treatment in the mutilated dentition for the preservation of the residual ridge. 2. Selection of patients for an overdenture should be based on past history of dental neglect, the status of the teeth and their periodontium, including present oral hygiene status, and patient motivation. The patients with a history of dental neglect, poor oral hygiene, and lack of motivation in having the teeth and the periodontium restored to health as well as strict compliance to a home-care regimen and recall schedule are not good candidates for treatment with an overdenture. 3. The choice of teeth or roots to serve as overdenture abutments must include their periodontal evaluation, which should consist of a detailed periodontal examination, diagnosis, prognosis, and treatment when this is indicated, including chemical protection (fluoride gel) and an oral hygiene regimen tailored to individual needs. 4. The knowledge and expertise in the selection and implementation of appropriate periodontal treatment modalities is of paramount importance in restoring optimum periodontal health to the overdenture abutments before overdenture fabrication. 5. The maintenance phase of the overdenture abutments as well as of the existing natural teeth is of critical importance in the preservation of health of these abutments and teeth. This maintenance phase should consist of periodic recalls based on individual needs; a detailed periodontal evaluation, including patient's motivation and status of oral hygiene and denture hygiene; and detection of caries. If necessary, appropriate periodontal and/or restorative therapy should be performed, and oral hygiene measures reinforced. This will ensure longevity of both abutment teeth or roots and of the existing natural teeth resulting in a long-term success of an overdenture. 6. Because there is evidence of high incidence of periodontal disease and dental caries in overdenture wearers, and because this evidence is attributed mainly to lack of motivation and compliance of adequate oral hygiene as well as to frequency of recall visits, patients should be made aware of the importance of their role in the maintenance phase of treatment and in the factors that lead to ultimate success of overdenture therapy. 7. With (a) proper selection of the patient and the abutment teeth, (b) adequate periodontal and restorative health and treatment to ensure optimum health prior to RPOD construction, (c) a well-designed home-care regimen and frequency of recalls, and (d) proper execution of maintenance care, changes for long-term success of overdenture therapy will be much improved.     

Successful periodontal maintenance of a case with Papillon-Lefèvre syndrome: 12-year follow-up and review of the literature.

BACKGROUND: Various approaches to treating the periodontal condition associated with Papillon-Lefèvre syndrome have been reported. These include oral hygiene instruction, use of mouthrinses, frequent debridement, multiple antibiotic regimens, periodontal surgery, extraction of hopeless teeth, and extraction of all deciduous teeth. Because Papillon-Lefèvre syndrome is rare, most publications are case reports, and very few document long-term successful treatment of the periodontal condition. METHODS: In 1986, a 3.5-year-old Indo-Canadian male was diagnosed with Papillon-Lefèvre syndrome and began periodontal treatment. Initial therapy consisted of debridement every 3 weeks, a 0.12% chlorhexidine mouthrinse, 2 regimens of metronidazole, and oral hygiene instruction for his parents. After 10 months it became apparent that the treatment was having little beneficial effect, since the periodontal destruction continued and teeth 51 and 61 exfoliated. At age 4, all remaining deciduous teeth were extracted and complete dentures inserted for the following 2-year edentulous period; then a 3-month maintenance schedule was maintained. RESULTS: The patient is now 17 years old and all his adult teeth are present with the exception of the third molars. His oral hygiene varies between moderate and good, with his most recent plaque score at 80% effectiveness. There are no probing depths greater than 4 mm, with the exception of the distal of the lower second molars where opercula are present. CONCLUSIONS: Extraction of all the deciduous teeth followed by a period of edentulousness may partially explain the fact that there has been no recurrent attachment loss in the permanent teeth up to age 17. Other explanations are discussed as part of the literature review of Papillon-Lefèvre syndrome.     

Impact of socio-demographic variables, oral hygiene practices and oral habits on periodontal health status of Indian elderly: a community-based study.

Periodontal disease is the most common cause of tooth loss. It is has insidious onset, chronic course, and commonly result due to cumulative effect of dietary habits, oral hygiene methods and oral habits practiced over the years. This study was planned to evaluate the periodontal health status of elderly population (above 60 years) in the community, using CPITN index, gingival recession, mobility of teeth and halitosis, using modified WHO Oral Health Survey Proforma. In addition, impact of several socio-demographic variables, oral hygiene practices, oral habits, chronic systemic diseases, dietary preferences and body mass index (BMI) on periodontal health status was also studied. It was found that prevalence of periodontal diseases in the elderly was high. Step-wise multivariate logistic regression analysis showed that periodontal diseases were directly correlated with age, oral hygiene practices and presence of cardiac diseases.     

Periodontal awareness, health, and treatment need in dental school patients. III. Treatment need

The need for periodontal treatment in a group of dental school patients was estimated by means of the periodontal treatment need system (PTNS). The findings were related to information about the regularity of dental visits, awareness of own disease, and periodontal treatment experience. All the patients required motivation and oral hygiene instruction (treatment need, class A). All their quadrants needed scaling or adjustment of subgingival restorations (treatment need, class B). As many as 71% of the patients and about 49% of the quadrants needed periodontal surgery (treatment need, class C). The mean periodontal treatment time per patient was 279 min (4 h 39 min). The middle age group (30-59 years) required more treatment time than the oldest group (greater than or equal to 60 years). This was probably due to more missing teeth in the oldest age group. There were no significant differences in treatment need between males and females. The regular dental visitors had a greater periodontal treatment need than the individuals visiting their dentist less frequently. This finding emphasizes the responsibility of the general practitioner in diagnosing and treating periodontal disease.     

Group therapy for periodontal disease. 1. Practical application of CPITN and the effects of group therapy

The purpose of this study was to determine the oral conditions in bakery workers (473 subjects) in addition to the screening system of O'Leary and CPITN, designed for rapid recording of the level of periodontal treatment needs, and to evaluate the periodontal treatments, managed by professional cleaning (scaling) and oral hygiene instruction. The assessment of the prevalence and severity of periodontal disease and resultant treatment needs in this group showed the characteristics of chronic periodontal disease in an advanced stage in persons aged 25-29 and 50-54. 228 patients were selected for treatment for nine months and examined accurately for their periodontal condition. 137 patients continued the following group therapy three times and were reevaluated. Following the group therapy, the oral hygiene status and subjective symptoms of bleeding were improved in all groups, the effectiveness of the treatment on sextants, scoring cord three, four, showed markedly high. To achieve the treatment with few individual appointments, it is necessary to increase our knowledge of how these groups live, depending on the diversity of life style and the differences in ethnic consciousness.     

Special oral hygiene and preventive care for special needs

Many dental patients have special preventive needs related to dental caries and periodontal disease, and most patients with intellectual or physical disabilities have specialized needs. This article suggests that these needs often go overlooked. To best care for patients with these needs, the dental practitioner should identify special oral hygiene needs among his or her patients, provide them with oral hygiene instruction and implement the specific oral hygiene preventive and treatment procedures described here.     

Papillon-Lefèvre syndrome: a successful outcome

BACKGROUND: Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive condition manifested clinically by hyperkeratosis of the palms and soles and rapidly progressive periodontitis resulting in loss of deciduous and permanent teeth. This case report describes the clinical periodontal findings and treatment of a 10-year-old male patient with PLS. The patient provided informed consent, and the study was conducted in accordance with the Helsinki Declaration of 1975, as revised in 2000. METHODS: Upon initial presentation, a full periodontal examination was completed. Conventional probing depths, clinical attachment levels (CAL), gingival index (GI), and plaque index (PI) were measured prior to initial therapy, which involved oral hygiene instruction and scaling and root planing. At reevaluation, initial treatment proved unsuccessful, and a surgical approach with concomitant systemic antibiotic therapy was implemented. In addition, the patient's dermatologist treated his palmoplantar keratoderma with systemic retinoids. Subsequently, the patient was placed on a strict 3-month maintenance protocol and was evaluated over a period of 1 year. RESULTS: Initial treatment with mechanical therapy, oral hygiene instruction, frequent recalls, and systemic antibiotics did not yield efficacious results. However, with the addition of surgical treatment, a favorable clinical outcome was obtained. CONCLUSIONS: Numerous treatment regimens for the periodontal disease seen in PLS can be found in the literature. We demonstrate successful treatment of the periodontal disease seen in this condition using mechanical therapy, systemic antibiotics, and surgical modalities; over a period of 1 year, we were able to achieve significant reductions in gingival inflammation and erythema.     

The management of periodontal disease in patients who have received radiation therapy for head and neck cancer

Osteoradionecrosis is a common, serious sequela of radiation therapy for oral cancer. Patients who are to receive radiation therapy should have preradiation dental evaluation and treatment, oral hygiene instruction, and close dental follow-up during and after radiation therapy. Teeth with significant periodontal disease should be extracted before radiotherapy. After radiation treatment, advancing periodontal disease can be initially managed with conservative treatment, scaling and root planing, tetracycline, and good oral hygiene. Periodontal disease is a possible source of infection and may therefore predispose a patient to osteo-radionecrosis.     

108颗牙种植体修复一年后的临床及X线评价

目的评价牙种植体负重1年后的临床疗效,并分析种植体周围粘膜炎症与骨吸收的关系。方法对70例种植义齿修复患者共108颗负重1年以上的IMZ和Frialit-2种植体进行临床及X线检查。结果所有种植体均无松动及种植体周围X线透射影等种植失败症状,牙槽骨高度降低的均值为（0.63±0.78）mm;粘膜有炎症的位点占所有检测位点的32.9%。重度炎症位点的骨吸收值明显高于轻度炎症位点和健康位点（P<0.05）。大多数种植义齿修复患者的口腔卫生及牙周健康状况均较差。结论IMZ和Frialit-2种植体负重1年后的临床效果满意;种植体周围粘膜炎症是种植体骨吸收的主要原因之一;消除或控制粘膜炎症、改善口腔卫生和邻牙的牙周健康状况,是接受种植的患者迫切需要解决的问题。     

Effect of controlled oral hygiene in overdenture wearers: a 3-year study.

The effect of controlled oral hygiene was studied in 35 overdenture patients involving 80 abutments over a period of 3 years. Intensive instruction and motivation in oral hygiene care were carried out prior to prosthodontic treatment and two to four times yearly during the study period. The initial dental and periodontal conditions were very poor, with a mean loss of proximal bone adjacent to the abutments of 62% +/- 17%. During the study period, it was possible to maintain mean plaque index scores of 0.40 to 0.70 and mean gingival index scores of 0.90 to 0.98 adjacent to the abutments. There was spontaneous regression of 4- to 5-mm periodontal pockets, whereas deeper pockets persisted. There was no relationship between the patients' initial plaque index score and the oral and denture hygiene observed during the study. The results of the study showed that it was possible to maintain teeth as overdenture abutments in elderly patients initially having a poor dental and periodontal status.     

Periodontal treatment of patients with Papillon-Lefèvre syndrome: a 3-year follow-up

BACKGROUND/AIM: Conventional mechanical periodontal treatment of Papillon-Lefevre syndrome (PLS) has often been reported to fail. This study describes the outcome of a non-surgical periodontal therapy including antimicrobial treatment of nine patients diagnosed with PLS. The patients originate from a total of 15 children and adolescents with PLS for which clinical characteristics are presented. METHODS: Clinical examination including conventional periodontal measurements. Initial treatment including oral hygiene instruction, scaling and root planing and systemic amoxicillin-metronidazole therapy for 6 weeks. After that the patients were enrolled in a 3-month recall maintenance program. In addition to this mechanical supportive maintenance treatment, tetracycline was prescribed and used continuously for 1.5 years. RESULTS/CONCLUSION: On five patients who were showing acceptable standard of oral hygiene and also compliance with the antibiotic medication, development of periodontitis on erupting teeth was prevented and disease activity on the previously periodontally involved teeth controlled during a 3-year period. Poor results of treatment were observed for three patients, all siblings. These patients failed to comply with the medication and also failed to improve their oral hygiene.     

Clinical effectiveness of subgingival irrigation with a pulsated jet irrigator versus syringe.

Previous studies have shown clinical and microbiological improvement with subgingival irrigation particularly after scaling and root planing. In this study we monitored the effects of saline irrigation on non-treated periodontal pockets. Ten subjects with severe periodontal disease and symmetrical lesions on multirooted teeth were selected. They had not received periodontal treatment or antibiotics for the previous 6 months. Patients were given simplified oral hygiene instructions. Neither scaling nor root planing was provided during the study. Two teeth were randomly selected per quadrant for subgingival irrigation with saline solution. One side was treated with a syringe and the other side with a pulsated jet irrigator with a modified tip, professionally administered. Clinical parameters (pocket depth, plaque index, gingival index, crevicular fluid, bleeding index, attachment level, and subgingival microflora) were evaluated on days 0, 15, 30, 60, and 90. Both subgingival irrigation products induced changes (reductions) in these indices during the study. Significant differences (P less than 0.001) with the oral irrigator were found for the following parameters: microscopy, pocket depth, crevicular fluid, and plaque index. In this study, professionally administered saline irrigation with a pulsated jet irrigator was more effective than syringe treatment with the same solution. Neither treatment resulted in a detectable gain in probing attachment level. Since gain in attachment level is achievable by other techniques, neither of these subgingival irrigation procedures alone can be considered adequate for periodontal therapy.     

Early diagnosis and treatment options for the periodontal problems in Papillon-Lefèvre syndrome: a literature review

Various approaches for treating the periodontal condition associated with Papillon-Lefèvre syndrome (PLS) have been reported. These include oral hygiene instruction, use of mouth rinses, frequent debridement, multiple antibiotic regimens, periodontal surgery, extraction of hopeless teeth, and extraction of all primary teeth. The objective of this paper is to review the literature on the different treatment approaches of patients with PLS and to illustrate the importance of early diagnosis as well as treatment in long-term maintenance of oral health. Because PLS is rare, most publications are case reports, and very few document long-term successful treatment of the periodontal condition. Several treatment approaches are summarized in this paper with the long-term reports. The importance of early diagnosis is highlighted. The recommendation is that young patients with skin lesions and severe periodontal destruction together with premature loss of teeth should be referred to a periodontist as early as possible. This should prevent or delay tooth loss and enhance early replacement of missing teeth for preservation of function and esthetics. In conclusion, successful periodontal management of PLS patients remains challenging. However, as our understanding of the etiological factors increases, it is hoped that successful treatment strategies will be developed.     

Factors associated with periodontal diseases in Jordan: principal component and factor analysis approach

This study was conducted to identify factors associated with periodontal disease in a Jordanian population using principal component and factor analysis techniques. Subjects were 603 dentate patients aged 15-65 years attending dental teaching clinics at the Jordan University of Science and Technology. Their oral hygiene and periodontal status were assessed using plaque index, gingival index, probing pocket depth, clinical attachment level, gingival recession, and number of missing teeth. Factor and principal component analysis and binary logistic regression were conducted to identify factors related to periodontal disease. Probing pocket depth, clinical attachment level, gingival recession, and number of missing teeth were sorted as the same factor and could be combined in one scale to measure the severity of periodontal disease. On the other hand, plaque index and gingival index were sorted as another factor and could be combined in another scale to correlate between oral hygiene and gingival status. The results demonstrated that increased age, low level of education, increased plaque index score, not brushing teeth, smoking more than 15 pack-years, and having diabetes were significantly associated with increased severity of periodontal disease. In conclusion, it was possible to form a standard scale, based on linear combinations of periodontal indices and parameters, to measure the severity of periodontal disease and determine its risk indicators.     

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.     

Longitudinal evaluation of a self-inspection plaque index in periodontal recall patients

This paper presents a controlled clinical trial to compare the effects of 2 programs for maintenance of oral hygiene after periodontal treatment. Oral hygiene instruction using a self-inspection plaque index was compared to traditional instruction using professional monitoring of disclosed plaque. 31 periodontal recall patients were randomly assigned to 2 groups. 15 patients in the self-inspection group were provided a manual that taught scoring of disclosed plaque on 6 teeth, a lighted dental mirror, and disclosing wafers. 16 patients in the traditional group were shown disclosed plaque in their own mouths, and were given feedback regarding oral hygiene skills. Instruction was given initially, at 2 weeks, at 1.5 months and at 3 months. The teeth were scaled at the start and at 3 months. Disclosed dentogingival plaque (before and after brushing), gingival bleeding on probing, and oral hygiene skills were assessed at 0, 1.5, 3 and 6 months. Initial mean plaque scores for only the self-inspection group decreased significantly at 1.5 months and were maintained throughout the study; however differences between groups were not observed at any time except at baseline. Gingival bleeding scores were low throughout the study for both groups. Results provide some evidence for the effectiveness of self-evaluation of disclosed plaque as a means for improving oral hygiene behavior in already-motivated patients.     

Effect of professional tooth cleaning on healing after periodontal surgery

Abstract The investigation was undertaken to find out whether favourable conditions for healing after periodontal surgery would develop in patients whose oral hygiene was professionally maintained at a high standard. The study was performed on 20 patients with advanced periodontal disease. Following an initial examination, comprising plaque index and gingival index scoring, measurement of pocket depths and loss of attachment, the patients were randomly distributed between a test and a control group. The patients first received detailed instructions for oral hygiene and were then subjected to periodontal surgery with the reverse bevel flap procedure. After surgery, the patients of the test group received professional cleaning of the teeth once every 2 weeks. The patients of the control group were recalled for scaling of the teeth once every 6 months. All patients were re-examined after 6, 12 and 24 months. It was found that the control patients were unable to maintain a high standard of oral hygiene with the result that the treatment of the periodontal disease failed. The patients of the test group maintained a high standard of oral hygiene, and the treatment of the periodontal disease was, therefore, successful.     

Oral health care needs among the middle-aged and the elderly in Hong Kong

Abstract A sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were clinically examined in an oral health survey of Hong Kong Chinese conducted in 1991. The examination procedures and diagnostic criteria for assessing restorative and extraction treatment need followed those recommended by the World Health Organization. The Community Periodontal Index-based periodontal treatment needs involving index teeth or their replacements were computed from separate clinic scores for maximum probing depth, presence of calculus, and bleeding after probing. A set of criteria for assessing prosthodontic treatment need was specially laid down for this survey. Examiners were calibrated before the survey, and the interexaminer reliability was found to be generally good. Besides reporting the various individual normative treatment need items in the traditional way, the present analysis used some holistic treatment-need categories which may have manpower-requirement implications for the classification of subjects. All dentate subjects surveyed required some treatment. Only 6% of the elderly, all edentulous, required denture work only. Of the 35–44-yr-olds, 42% needed scaling and oral hygiene instruction only, which could be provided by dental hygienists. The treatment needs of the vast majority of the middle-aged and the elderly (mainly scaling; simple fillings; and extractions, dentures, or both) could be easily handled by general dentists. Only about one-fifth of the subjects in both age groups required some complex care such as endodontics, crowns, and advanced periodontal treatment, which could be delivered by senior dentists or dentists with specialist training.