Application of the Community Periodontal Index of Treatment Needs (CPITN) in a population of young Brazilians

Recently WHO has launched an index for assessing the periodontal treatment needs of a population in terms of resources required. This Community Periodontal Index of Treatment Needs was applied in 308 Brazilian 15-yr-old schoolchildren from a population with a high prevalence of periodontitis. The results showed that all subjects needed some kind of care. Totally, 4133 time units were required. Most of the time needed was for motivation and instruction in oral hygiene, and scaling. Several individuals assigned for complex treatment due to pockets deeper than 5.5 mm showed no signs of radiographic bone loss, and in the cases with bone loss, the lesions were few and small. The CPITN therefore seemed to overestimate the need for treatment in this young population. To overcome this problem, it was suggested that complex treatment should not be included in planning of systematic periodontal care for young populations, and that subjects with true periodontal lesions should be given priority in community programs.     

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.     

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.     

Periodontal condition and treatment needs (CPITN) in the Bulgarian population aged over 60 years

AIM: To investigate the periodontal condition and treatment needs of elderly people in Bulgaria. SUBJECTS: 653 subjects over 60 years of age (263 males and 390 females). METHOD: The study was carried out in 1999 using WHO recommended survey techniques. The analysis included only the results of the subjects eligible for assessment using CPITN, 497 subjects (206 males and 291 females). RESULTS: More than 88% of the subjects were affected by periodontal disease of various severity. The percentage of subjects with pathological pockets (CPITN 3, 4) increased with age. CONCLUSIONS: In comparison to the large needs of periodontal therapy in general, the complex treatment needs (TN 3) were relatively small. The major volume of needs related to periodontal care lie within the competence of the general dental practitioner to treat.     

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.     

A longitudinal evaluation of Periodontal therapy using the CPITN index

A retrospective 3-year longitudinal evaluation of periodontal therapy using the CPITN index was performed. Each sextant in 123 patients exhibiting moderate to advanced adult periodontitis was given a score that recorded the condition of the worst affected site in that sextant. Whereas very few sextants had an initial CPITN Code 0, the prevalence of sextants with an initial CPITN Code 4 was quite high. Posterior sextants with CPITN Code 4 were more likely treated with surgery than sextants with CPITN Code 3. Although surgery appeared to be more effective than non-surgical therapy in reducing the CPITN Codes for posterior sextants at 1 year, there were no differences between the 2 forms of therapy at the 3-year examination. Anterior sextants were treated with a non-surgical approach regardless of CPITN Code at either initial examination or reevaluation. The outcome of therapy in this study using the CPITN index is comparable to other studies utilizing mean pocket depth and attachment level. Although the CPITN index does not prescribe specific therapeutic interventions, this index provides a useful tool to monitor patients in the treatment of periodontitis.     

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.     

Assessment of periodontal disease and dental caries in a population survey using the CPITN, GPM/T and DMF/T indices

2263 randomly selected subjects, aged 15-19, 20-24, 25-29, 30-34, 35-44, 45-54, 55-64, and greater than 64 yr, were assessed for periodontal status, caries status and treatment needs using the Community Periodontal Index of Treatment Needs (CPITN), the ratio of Gingivitis: Periodontitis: Missing teeth (GPM/T index) and the DMF/T index. The advantages of full mouth examination were compared to partial recordings. The CPITN underestimated deep pocketing especially in older age groups and in younger groups overestimated the need for scaling. Although the mean GPM/T number of periodontally affected teeth is in the range of 9-13 teeth and stable throughout the age groups there were age-dependent high risk groups for developing shallow pocketing (20-24 yr) and deep pocketing (45-54 yr), whereas adolescents were at high caries risk. The increase in the number of missing teeth was dramatic after the age of 54 yr only one decade after the high risk age for deep pathologic pockets.     

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.     

Photometric CIELAB Analysis of the Gingiva: A Novel Approach to Assess Response to Periodontal Therapy

Background: A new photometric method is introduced for assessment of gingival condition and changes after periodontal therapy. Methods: Clinical data (probing depth [PD], plaque index [PI], gingival index [GI], bleeding on probing [BOP], and clinical attachment level) and photographs from 53 participants (26 males and 27 females) undergoing initial periodontal treatment were used for this analysis. Each maxillary anterior area was photographed before and 3 months after treatment. Digital image analysis was performed around one incisional tooth, and color data were expressed in terms of L*, a*, and b* values in accordance with the CIELAB color space. Non‐parametric Mann–Whitney U test was used for within‐group comparisons of disease resolution, as well as means and standard deviations of clinical parameters and ΔL, Δa, and Δb values from baseline to re‐evaluation. Results: Significant reduction in mean PI, GI, PD, and BOP were found after treatment in all groups (P <0.001). Significant differences (P <0.05) were recorded by diagnosis of chronic periodontitis in the a* coordinate when comparing treatment results with the baseline (P <0.004). Conclusion: Results of this study suggest potential benefit in using photometric analysis to assess gingival changes after therapy.     

Community Periodontal Index of Treatment Needs (CPITN) in KwaZulu and Namibia in 11-year-old children in 1988

A sample of 603 11-year-old children from four low fluoride (less than 0.15 ppm) and one higher fluoride (1.56 ppm) communities in Namibia and KwaZulu were examined in 1988 using the CPITN. In a rural low fluoride community in Namibia only 6 per cent of children had healthy mouths compared with 42-58 per cent in the other communities. The main periodontal lesion seen was gingival bleeding (19-47 per cent) followed by calculus (6-47 per cent). There is a need for both oral hygiene improvement and simple intervention.     

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

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

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 conditions in adults, 35–44 years of age: an overview of CPITN data in the WHO Global Oral Data Bank

Results of 28 CPITN surveys in 24 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 July 1986 are assembled in an overview presenting: percentages of persons according to the highest score for each person, the estimated national percentages of edentulousness and the mean numbers of sextants affected per person. It is concluded that for a large majority in most of the populations observed, the progress of periodontal disease has been slow and seems to be compatible with retention of a natural dentition until at least the age of 50.     

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.