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

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

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.     

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

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

Periodontal 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.     

The validity of the CPITN scoring and presentation method for measuring periodontal conditions

Abstract The CPITN is used widely in estimating periodontal treatment needs and, in many cases also to make generalizations about periodontal disease. It is therefore imperative that the heirarchical scoring method used to allocate CPITN scores is validated, and that the presentation of CPITN data reflect the true distribution of periodontal conditions. Data from one study carried out in Melbourne, Australia and one in Jakarta, Indonesia were used to compare CPITN scores on a mouth, sextant and tooth basis. Clinical periodontal components were compared with CPITN scores to establish the validity of the CPITN hierarchical scoring method. The distributions of CPITN scores varied widely on a mouth, sextant and tooth basis, and CPITN scores frequently differed from those indicated by the periodontal components. It was concluded that CPITN data should be presented not only as the % of subjects with each score, but also as the % of sextants, and. if possible, the % of tooth sites with each CPITN score. It was also concluded that there is an advantage in measuring components (calculus and bleeding) as well as CPITN in order to limit the overestimation of treatment needs, particularly for anterior teeth.     

Changes in periodontal conditions of children and adolescents from Araraquara, Brazil: 1995-1998

The aim of this study was to compare the periodontal conditions in 7-15-year-olds from Araraquara, SP, Brazil in 1998 with data from 1995. A systematic random sample was drawn from the population of children and adolescents enrolled in all public schools in 1998. The survey was conducted by trained examiners using the CPITN and WHO diagnostic criteria. Results showed an increase in the percentage of students of all ages with healthy periodontal conditions (from 14% in 1995 to 33% in 1998; p < 0.01). An increase in the mean number of healthy sextants (from 3.2 to 4.4; p < 0.0001), a decrease in the mean number of bleeding sextants (from 2.5 to 1.2; p < 0.0001) and no difference in the mean number of sextants with calculus were also observed. At the age of 15, 54% of the students had 5-6 healthy sextants in 1998 compared to 19% in 1995 (p < 0.01). Despite the improvement observed in the periodontal conditions, efforts must be increased in order to achieve the WHO goal for the year 2010 of no more than one sextant affected by bleeding or calculus at the age of 15.     

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.     

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.     

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.     

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.     

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.     

Periodontal treatment need of the 6th-grade Jordanian pupils

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

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.     

Assessment of periodontal knowledge and periodontal status of an adult population in Jordan

The aim of this study was to assess periodontal knowledge and periodontal status in 20-60-year-old adult population in northern Jordan. A convenient sample consisting of 722 adults was included in this study. A questionnaire incorporating items related to socio-demographic and periodontal knowledge questions was completed before clinical examination, using the Community Periodontal Index of Treatment Needs (CPITN). The results showed that the proportions of subjects who reported bleeding gums, gums' irritation, rough tooth surface and gum disease decreased steadily with age, there is an evident linear trend with high statistical significant difference among various age groups (P < 0.001). Furthermore, the proportions of subjects who answered correctly the periodontal knowledge questions related to plaque definition and its role in disease aetiology and prevention, decreased with age, with a high significant difference for all knowledge questions (P < 0.001). The prevalence of subjects with healthy periodontium (score 0) decreased with age, being 41.1% among 20-29-year-old group and 11.1% in 50-60-year-old group. Similar trend was seen for bleeding on probing (score 1) whilst calculus deposit (score 2) was the major problem in all age groups over 29 years. The prevalence of periodontal pockets was relatively low, with a range of 4.5-18.6% for shallow pockets (score 3) and 2.9-11.1% for deep pockets in younger and older age groups, respectively. Younger age group had more healthy sextants than older age groups. In addition, sextants with bleeding on probing were highest in 20-29-year-old age group (1.8) compared with that in 50-60-year-old age group (0.60) whilst those with calculus deposits varied slightly among different age groups (1.50-1.65). Sextants affected by shallow or deep pockets increased steadily with age. Such a finding was also noted in excluded sextants, with an increase from 0.15 at 20-29 year-old group to 0.94 at the age of 50-60 years. It is concluded that health knowledge and status related to periodontal disease is still poor in northern Jordan. Therefore, dental health education provision is necessary to improve oral health knowledge and conditions among population in general and among older population in particular.     

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.     

Periodontal treatment needs in a follow-up study among adults with diabetes in Finland

We assessed changes in periodontal treatment needs among patients with diabetes and the risk factors involved in this phenomenon. The sample consisted of 120 dentate subjects, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic. They underwent periodontal examination in 1999 and were re-examined in 2001. The drop-out rate was 4%. Clinical periodontal examination included identification of visible plaque, the presence of calculus, and use of the Community Periodontal Index of Treatment Needs (CPITN) index. Diabetes-related factors consisted of information about duration of diabetes, complications, and HbA1c values. Oral health-related factors were collected by questionnaire. The CPITN index proved to be insensitive to change. Pathological pockets (CPITN 3 or 4) were found in 80% of subjects (n = 115) and 48% of sextants (n = 627); in 1999, the corresponding rates were 77% and 49%. The tooth-based individual CPITN index (code 3 or 4) revealed periodontal deterioration in 38 patients. Smoking and infrequent interdental cleaning were significant factors explaining periodontal deterioration in logistic regression. Risk factors should be taken into account when planning prevention, treatment, and supportive periodontal therapy strategies. In diabetes care, the common risk factor approach can be implemented to promote oral health among individuals with diabetes.     

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.     

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.     

Changes in the Community Periodontal Index of Treatment Needs (CPITN) after periodontal treatment in a general dental practice.

The result of a study of the effectiveness of treatment of chronic periodontal disease in a general dental practice using CPITN and the time required to treat patients with differing CPITN scores indicated that although there were significant reductions in calculus and shallow pockets, the treatment did not eliminate positive CPITN scores; 41% scored 1, 24% scored 2, and 34% scored 3 or 4 after treatment. Very few patients had 'healthy' periodontal sextants at the first visit; the most frequent CPITN category was 3. Patients in this category took up most of the treatment time. The treatment times per patient were much lower than the estimates of the World Health Organisation for similar treatments.     

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.