Periodontal treatment needs in a population of Ljubljana, Yugoslavia

1692 citizens of Ljubljana in the age range from 15 to 65 yr participated in a survey to assess their periodontal treatment needs. Eighty-three of the participants (4.9%) were edentulous and excluded from the study. Of the 1609 dentate subjects only 2.4% were free of any signs of periodontal disease. According to the Community Periodontal Index of Treatment Needs, (CPITN), reversible gingivitis was present in 19.9% of the population, calculus and shallow pockets (4-5 mm) in 57.4%, and deep pockets (greater than or equal to 6 mm) in 20.3% of the examined participants. Bleeding on probing was the most common finding in a group of 15-yr-old subjects, calculus was most frequently found in 25- and 35-yr-old groups, and shallow and deep pockets in 45-, 55- and 65-yr-old adults. Complex treatment needs increased with age, reaching 42.9% in the 65-yr-old population. However, deep pocketing was in 60% limited to one sextant of the participants with complex treatment needs.     

Periodontal treatment needs in a Spanish school population

The aim of this study was to assess the periodontal treatment needs of the population under 20 years of age in Spain. 1469 young people, aged 7, 12 and 15-19 years, and representing the urban (60%) and rural (40%) population from Spain were evaluated using the Community Periodontal Index of Treatment Needs (C.P.I.T.N.). In the first age group (7 years), 12% presented calculus or overhanging restorations, and 45% had bleeding upon probing only. In the age group of 12 years the proportion of individuals with calculus, overthanging restorations or moderate pocket depths was 39%, while 38% had gingivitis as their highest treatment need. In the oldest group (15-19 years) the number of subjects with bleeding upon probing decreased to 17%, while the percentage of individuals having moderate pockets, calculus or overhanging restorations increased to 67%. 1% of this youngsters had pockets of 6 mm. or over. At age 7, only 30% had "acceptable gingival health", and no more than 15% of the 18 year-olds reached this condition.     

Periodontal status of 14–16-year-old Danish schoolchildren

Abstract – The purpose of this study was to determine the prevalence of periodontal disease in teenagers. The survey was conducted on 325 children aged 14,15 and 16 years, living in Aarhus, Denmark. Pocket depth and loss of attachment were measured in mm at the maxillary and mandibular first molars and incisors. Plaque, calculus and gingival bleeding on probing were recorded. A total of 221 children (68%) had 4–5 mm deep pockets and 19 children (5.8%) had pockets deeper than 5 mm on at least one tooth Approximately 11% of the subjects showed loss of attachment on at least on tooth. The frequency of surfaces with plaque and gingivitis was high in all three age groups. Plaque, gingivitis, deepened pockets and loss of attachment were most frequently observed on interproximal surfaces. No significant differences were observed between the sexes with regard to periodontal disease.     

Association of lifestyle with periodontal health

Abstract All the 1012, 55-yr-old citizens of Oulu (a medium-sized Finnish town) were invited to a clinical examination, and 780 of them participated. The associations of lifestyle with periodontal health were analyzed in the 527 dentate subjects. Periodontal pockets deeper than 3 mm were recorded as a percentage of the surfaces at risk. Lifestyle was measured by questions about dietary habits, smoking habits, alcohol consumption and physical activity. Lifestyle had an independent association with periodontal health. Periodontal pocketing increased with an unheallhier lifestyle. Lifestyle could explain some of the social and sex differences in periodontal health.     

Self-reporting of periodontal diseases and clinical assessment outcome in a Swedish urban population of smokers and non-smokers

The aim of this study was to determine whether there is an association between self-reporting of periodontal diseases and outcome in a clinical examination, and whether any difference is present in awareness of periodontal status between smokers and non-smokers. Participants comprised 1676 adults (838 M and 838 F aged between 31 and 40 years), 564 of whom reported being smokers. Subjects were asked via questionnaire whether they thought they had periodontal disease and why. A total of 1655 subjects answered the questionnaire and were subsequently divided into those who suspected having periodontal disease (Yes-group) and those who did not (No-group). A full-mouth clinical examination was carried out in all subjects. Female smokers in the Yes-group had a significantly higher number of teeth with pockets > or = 5 mm (P < 0.001) and a higher calculus index (CI-S, P < 0.01) than female smokers in the No-group. Male smokers in the Yes-group had significantly less remaining teeth (P < 0.01), more teeth with pockets > or = 5 mm (P < 0.001), and a higher CI-S (P < 0.05) than their counterparts in the No-group. For smokers, multivariate logistic regression analysis yielded an odds ratio (OR 3.21 [95% CI 1.73 5.74]) of self-reported periodontal disease to periodontitis outcome which was significant (P < 0.001). This association remained significant (P < 0.01) after adjustment for confounding factors. Subjects who reported having periodontal disease, especially those who also reported having movable teeth, were confirmed to have the disease. Smokers were more aware of their periodontal status than non-smokers.     

A retrospective study of periodontal disease severity in smokers and non-smokers

BACKGROUND: Smoking has been associated with increased risk of periodontitis. The aim of the present study was to compare the periodontal disease severity of adult heavy smokers and never-smokers referred for assessment and treatment of chronic periodontitis. METHODS: A random sample of patients with at least 20 teeth, stratified for smoking and age (5-year blocks, 35 to 55 years), was selected from an original referral population of 1,221 subjects with chronic adult periodontitis. Adequate records for 59 never-smokers and 44 subjects who smoked at least 20 cigarettes per day were retrieved. The percentage of alveolar bone support was measured from dental panoramic radiographs with a Schei ruler at x3 magnification with the examiner unaware of the smoking status. Probing depths at six sites per tooth were obtained from the initial consultation. RESULTS: There was no significant difference in age between groups. Smokers had fewer teeth (p<0.001), fewer shallow pockets (p<0.001) and more deep probing depths (p<0.001). The differences were greater in subjects 45 years of age and over. In this age group, smokers had approximately 13% more bone loss, 15% more pockets in the 4-6 mm category and 7% more pockets in the >/= 7 mm category than the never-smokers. CONCLUSIONS: This study confirmed that smokers had evidence of more severe periodontal disease than never-smokers. The differences increased with age confirming an exposure-related response.     

Periodontal status and treatment needs in the Chiangmai/Lamphun provinces of Thailand

As part of an oral health survey concerned with the evaluation of a collaborative primary oral health care program, the CPITN system was used to determine the periodontal status and treatment needs of 2009 Thai people aged 12-44 yr. Calculus dominated the CPITN scores. The percentage of persons with healthy periodontal tissues was small, ranging from 0.7% at age 35-44 to 4.1% at age 12. Ranges for other highest scores were bleeding-0.4% at age 35-44 yr to 6.1% at age 12 yr; calculus-62% at age 35-44 yr to 92.6% at age 17-18 yr. Pocketing did not occur to any significant extent until age 35-44 where 23.9% had 3-5 mm pockets and 12.8% had pockets 6 mm or deeper. 15-18-yr-olds who had received prior care from a Village Scaler had a significantly higher number and proportion of healthy sextants than those who had not received such care. No such effect was demonstrated in 35-44-yr-olds. The need for caution in the interpretation of this result is stressed. Attention is drawn to the desirability of differentiating between supra- and sub-gingival calculus in the CPITN scoring system and to the excessive treatment requirements that arise from classifying everyone with calculus as requiring prophylaxis and scaling. A great deal of improvement will need to be affected if the Thai national and global goals for periodontal health are to be achieved in the districts covered by this survey.     

Periodontal conditions in 35-44 and 65-74-year-old adults in Denmark

OBJECTIVES: To assess the periodontal health status in the Danish adult population and to analyze how the level of periodontal health is associated with age, gender, urbanization, socio-economic factors, and dental visiting habits; furthermore, to compare the periodontal health status of Danish adults with that of adults in other industrialized countries. MATERIAL AND METHODS: A cross-sectional study of a random sample of 1,115 Danish adults aged 35-44 years and 65-74 years. Data were collected by means of personal interviews and by clinical examinations in accordance with the World Health Organization Basic Methods Criteria. RESULTS: The clinical examination revealed a low prevalence of healthy periodontal conditions in both age groups: at age 35-44 years 7.7% and at age 65-74 years 2.4% had healthy periodontal conditions. A high proportion of the elderly had scores of severe periodontal health; more than 82% of older participants had pockets of 4-5 mm or deeper against 42% in younger adults. In both age groups, the mean number of teeth with periodontal pockets deeper than 4-5 mm was high in individuals with low education. Only a weak association between periodontal health and income was found. High Community Periodontal Index scores were seen for irregular dental visitors, but in the 35-44-year-olds deep periodontal pockets were more often seen among young regular dental visitors. The multivariate analysis showed that participants with low or medium levels of education had significantly more teeth with shallow and deep pockets than those with high education. Persons with regular dental visiting habits had fewer teeth with gingival bleeding, shallow and deep pockets than individuals with irregular dental visiting habits. CONCLUSION: Reorientation of the Danish dental health-care services is needed with further emphasis on preventive care, and public health programs should focus on risk factors shared by chronic diseases in order to improve the periodontal health of Danish adults.     

Community periodontal index of treatment needs and prevalence of periodontal conditions

BACKGROUND/AIMS: In 1977, the World Health Organization (WHO) proposed a new index, the community periodontal index of treatment needs (CPITN) to evaluate the periodontal treatment needs of populations. The aim of this study is to compare different approaches of recording and presenting the CPITN. METHODS: A sample of 2110 subjects aged 35-44 years were examined between September 1994 and July 1995, throughout the province of Quebec, Canada. For each tooth (3rd molars excluded), the presence of bleeding and calculus, the level of epithelial attachment, and the depth of periodontal pockets were measured. Periodontal pocket depths were measured from the edge of the free gingiva, at 2 sites (mesiovestibular and vestibular), as well as all around the tooth. RESULTS: Only 8.5% of adults had at least one tooth with a 6 mm or deeper periodontal pocket when probing on 2 sites, whereas if probing is done all around the tooth, this percentage is 2.5x higher (21.4%). The partial recording of pocket depths (10 index teeth recommended by WHO, or 2 quadrants chosen at random) resulted in an underestimation of the prevalence of subjects with at least one tooth with a periodontal pocket (CPITN score 3 and 4). Among subjects with at least one tooth with a 6 mm or deeper periodontal pocket, 12% were not detected with the 10 index teeth recording, and 25% go undetected with the measure on 2 quadrants. Finally, using the % of subjects with periodontal pockets overestimates the prevalence of deep pockets compared with using sextants. Indeed, close to 30.0% of sextants have no treatment needs, whereas only 5.2% of subjects are in this category. Similarly, 7.7% of sextants have at least one tooth with a 6 mm or deeper periodontal pocket, yet there are 3x more subjects in this category (21.4%).     

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.     

Partial indices as indicators of the severity and prevalence of periodontal disease

The purpose of this study was to analyse the reliability of partial examination in the assessment of the average severity and the prevalence of periodontal disease. A total of 126 subjects aged 15-30 years and 160 subjects aged 31-68 years were examined for the presence or absence of gingival bleeding, supra- and subgingival calculus and pocket depths of 4-5 mm or 6 mm and over on six surfaces of each remaining tooth. From this pool of data three sets of average severity and prevalence scores were extracted. One was based on the full mouth examination; one on observations made from the ten index teeth of the Community Periodontal Index of Treatment Needs (CPITN); and one on the six index teeth of the Periodontal Disease Index. Average severity scores were obtained as accurately from the six Ramfjord teeth as from full mouth examinations for all periodontal disease indicators except for 6 mm or deeper pockets. When the assessments were based on the ten CPITN index teeth, the average severity scores exceeded those based on full mouth examinations for all indicators recorded and the prevalence figures were higher than those based on the six Ramfjord teeth. Even with the CPITN there was an under-estimate of the proportion of individuals affected, ranging from 16 per cent for 4-5 mm pockets to 21 per cent for 6 mm and deeper pockets in the older age group.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of CPITN cross-tabulations--a research perspective

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

Distribution of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia in an Australian population

BACKGROUND, AIM: The present study describes (i) the natural distribution of the three putative periodontopathogens Porphyromonas gingivalis, Prevotella intermedia and Actinobacillus actinomycetemcomitans in an Australian population and (ii) the relationship between these organisms, pocket depths and supragingival plaque scores. METHODS: Subgingival plaque was collected from the shallowest and deepest probing site in each sextant of the dentition. In total, 6030 subgingival plaque samples were collected from 504 subjects. An ELISA utilising pathogen-specific monoclonal antibodies was used to quantitate bacterial numbers. RESULTS:: A. actinomycetemcomitans was the most frequently detected organism (22.8% of subjects) followed by P. gingivalis and P. intermedia (14.7% and 9.5% of subjects respectively). The majority of infected subjects (83%) were colonised by a single species of organism. A. actinomycetemcomitans presence was over-represented in the youngest age group but under-represented in the older age groups. Conversely, P. gingivalis and P. intermedia presence was under-represented in the youngest age group but over-represented in the older age groups. Differing trends in the distribution of these bacteria were observed between subjects depending upon the site of the infection or whether a single or mixed infection was present; however, these differences did not reach significance. Bacterial presence was strongly associated with pocket depth for both A. actinomycetemcomitans and P. gingivalis. For A. actinomycetemcomitans, the odds of a site containing this bacterium decrease with deeper pockets. In contrast, for P. gingivalis the odds of a site being positive are almost six times greater for pockets >3 mm than for pockets < or =3 mm. These odds increase further to 15.3 for pockets deeper than 5 mm. The odds of a site being P. intermedia positive were marginally greater (1.16) for pockets deeper than 3 mm. CONCLUSIONS: This cross-sectional study in a volunteer Australian population, demonstrated recognised periodontal pathogens occur as part of the flora of the subgingival plaque. Prospective longitudinal studies are needed to examine the positive relationship between pocket depth and pathogen presence with periodontal disease initiation and/or progression.     

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.     

Assessment of the WHO partial recording approach in identification of individuals highly susceptible to periodontitis

The use of the WHO partial recording approach (CPITN) in the identification of 20-30-yr-old individuals with high past or present susceptibility to periodontitis was investigated in two studies in a factory population. Comparison with a traditional assessment in 149 subjects indicated that the probing depths and bleeding scores of the partial recording sites correlated well with the other sites which were less prone to periodontal disease than the CPITN sites, and that all the 23 subjects with deep pockets would have been identified by the use of the CPITN sites alone. However, when 75 of the subjects were re-examined using the partial recording sites, assessment of loss of clinical attachment levels indicated that only 16 of the 33 subjects who had loss of 2 mm or more clinical attachment at two or more sites had deep pockets, indicating that in this group assessment using pocket depth measurement alone seriously underestimated the proportion of individuals with a high past or present susceptibility to periodontitis.     

Oral health profile in an institutionalized population of Italian adults with mental retardation

The oral health of 219 residents with mental retardation living in a long-term-care institution near Milan was assessed. The dental and periodontal status, daily habits, oral hygiene, and oral mucosal status were evaluated. Of the sample, 179 (81.7%) were males. The mean age of the residents was 61.3 years, and the degree of cooperation was evaluated as good for 131 subjects (59.8%), fair for 79 (36.1%), and poor for nine (4.1%). The percentage of residents who were edentulous was 21.5% (47 subjects), of whom 28 subjects (59.6%) were without dentures. Evaluation showed an overall DMFT of 23.1, and the average number of missing teeth was 20.5. All subjects had periodontal disease: Forty-five subjects had calculus and/or shallow pockets (4–5 mm); 61 had deep pockets (≥ 6 mm). The most common mucosal lesion was oral stomatitis (49.3%). These findings underline the need for special programs aimed at institutionalized subjects with mental retardation.     

Periodontal treatment needs in Argentine adult subjects

The aim of the present study was to assess the periodontal treatment needs of the population that spontaneously sought treatment from general dentists. 3694 patients (2000 females and 1494 males, age range between 18 and 84 years) were evaluated using the Community Periodontal Index (CPI). Data were reported according to the percentage of subjects with the highest Score: 14.3% presented pocket depth > or = 5.5 mm (Score 4), 26.4% pocket depth between 3.5 and 5.5 (Score 3), 38.3% presented pockets < or = 3.5 mm with calculus or overhanging restorations (Score 2), 17.2% pockets < or = 3.5 mm with bleeding upon probing without calculus (Score 1) and 3.2% were healthy (Score 0). Analyzing the data according to age it was observed that in the group > 40 years the percentage of patients with Score 4 was higher (25.1%) compared to the other two groups of 18-34 years (6.4%) and 34-45 years (14.3%). Only 16.4% of the patients consulted for periodontal reasons (gingival bleeding or tooth mobility), whereas 88% requested treatment for other reasons (pain, caries, esthetics, replacement of teeth, etc.). However 77% of the patients in this last group needed periodontal treatment. 96.8% of the patients attending the general dentistry office needed periodontal treatment: 17.2% oral hygiene instruction, 65.2% oral hygiene instruction and scaling and 14.3% complex treatment.     

Salivary flow rate and periodontal infection - a study among subjects aged 75 years or older

Oral Diseases (2011) 17 , 387–392 Objective: To analyse the relation of stimulated and unstimulated salivary flow rates to periodontal infection in home‐dwelling elderly people aged 75 years or older. Subjects and Methods: This study was based on a subpopulation of 157 (111 women, 46 men) home‐dwelling, dentate, non‐smoking elderly people (mean age 79.8, SD 3.6 years) from the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly Study). The data were collected by interview and oral clinical examination. Results: Persons with very low (<0.7 ml min^?1) and low stimulated salivary flow rates (0.7–<1.0 ml min^?1) had a decreased likelihood of having teeth with deepened (≥4 mm) periodontal pockets, RR: 0.7, CI: 0.5–0.9 and RR: 0.7, CI: 0.5–0.9, respectively, when compared with those with normal stimulated salivary flow. Persons with a very low unstimulated salivary flow rate (<0.1 ml min^?1) had a decreased likelihood of having teeth with deepened (≥4 mm) periodontal pockets, RR 0.8, CI: 0.6–1.0, when compared with subjects with low/normal unstimulated salivary flow. Conclusions: In a population of dentate, home‐dwelling non‐smokers, aged 75 years or older, low stimulated and unstimulated salivary flow rates were weakly associated with a decreased likelihood of having teeth with deep periodontal pockets.     

Periodontal condition of pregnant women assessed by CPITN

The periodontal conditions of 2424 pregnant and 1565 non-pregnant women were assessed according to the community periodontal index of treatment needs (CPITN). The aim of this survey was to obtain information which is necessary for the planning of preventive programs of periodontal disease for pregnant women. 95% of the pregnant women and 96% of the non-pregnant women had some signs of periodontal disease. The % of pregnant women having 4 or 5 mm pockets was significantly higher than that of non-pregnant women, increased with the month of pregnancy, reached a maximum of 31% in the 8-month group, but decreased to the control level in the 9-month group. These changes were interpreted to suggest that the increase of pocket depth during pregnancy was caused by gingival enlargement rather than by periodontal destruction. The results show that pregnant women had a healthier periodontal condition when compared with non-pregnant women, i.e., the number of sextants with healthy periodontal tissues was higher, the % of people having deep pockets (6 mm or deeper) was lower, and the need for prophylaxis was lower in pregnant than in non-pregnant women. These findings suggest that a special program of periodontal disease prevention for pregnant women is not necessary.