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.     

Tooth and root conditions in the middle-aged and the elderly in Hong Kong

Abstract In an oral health survey of Hong Kong Chinese conducted in 1991, a sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds were interviewed and clinically examined. The examination procedures, instruments, and diagnostic criteria used to detect coronal caries followed those recommended by the World Health Organization (1987). The diagnostic criteria used to assess root-surface caries were based on those used in a national oral health survey of US employed adults (National Institute of Denial Research. 1987). Calibration of examiners was conducted before the survey and the interexaminer reliability was found to be very high; the kappa statistics were 0.93 and 0.91 for the younger and older age groups, respectively. None of the 35–44-yr-olds were edentulous and 96% had 21 teeth or more. The prevalence of edentulousness among the elderly was 12%. The DMFT indices of the younger and older age groups were 8.7 and 18.9, respectively. In both age groups, MT was the major component of the DMFT index, and female subjects had a slightly higher score. The prevalences of decayed/filled roots were 7% and 26%i for the 35–44- and 65–74-yr-olds, respectively. As compared with previous surveys conducted in Hong Kong, there has been a 40% reduction in the DMFT index of the 35–44-yr-olds since 1968, but little change in the tooth and root conditions was noted between 1984 and 1991.     

Tooth spaces in and prosthetic treatment received by the middle-aged and the elderly in Hong Kong

Abstract The purpose of this study was to describe the state of the dentition of middle-aged and elderly Chinese in Hong Kong in terms of teeth present, tooth spaces, and prosthetic treatment received. In an oral health survey conducted in 1991 in Hong Kong, a sample of 372 35–44-yr-olds and 537 noninstitutionalized 65–74-yr-olds was interviewed and clinically examined. In all dentate subjects, each tooth was scored for the presence/absence of that tooth, a tooth space of 5.5 mm which had not been treated, or the presence of a denture or pontic replacing that tooth. Each denture was assessed according to a set of criteria. None of the 35–44-yr-olds were edentulous and the mean number of teeth present was 27.5. About 40% of the third molars and about 35% of the mandibular first molars were missing. For only 1% of the missing teeth had space closure resulted in missing teeth not being recorded as tooth spaces or treated tooth spaces. Overall, 72% of the 35–44-yr-olds had no prosthesis. 17% had a bridge or bridges, 12% had a denture or dentures, and 1% had both. Of the 65–74-yr-olds, 12% were edentulous, and the dentate subjects had a mean number of 17 teeth present. About 70% of the molars were missing. Overall, only 29% of the elderly had no prosthesis, 52% had a denture or dentures, 33% had a bridge or bridges, and 13% had both. Only 35% and 28%, respectively, of the middle-aged and elderly denture wearers had no complaint about their dentures. There were more assessed problems in the dentures of the elderly than in those of the younger adults, over one-third of the partial dentures and half of the mandibular complete dentures being unstable and unretentive.     

Survey of the oral health needs of institutionalised elderly patients in Western Australia

An epidemiological survey of the oral health needs of 1144 elderly patients was conducted in hospitals and nursing homes in Western Australia. Patients were categorised as being either totally dependent (requiring intensive nursing care) or partially dependent (requiring nursing supervision). Of all patients the mean age was 80.2 yr, 70% were women, 74% were edentulous, and 70% needed some form of prosthetic care. Of all dentate patients 56% needed dental scaling (and 17% needed complex periodontal treatment), 47% needed some restorative treatment (with a mean need per patient of 1.1 coronal restorations and 0.4 radicular restoration), and 29% needed one or more dental extractions (with a mean need of 1.4 extractions per patient). Partially dependent patients had statistically significant higher needs for prosthetic work than did totally dependent patients, while the converse applied to extraction needs, but in all other aspects the needs of the two categories of patient did not differ significantly.     

The Hong Kong Adult Oral Health Survey – 1991: background, study population, and methods

Abstract This second adult oral health survey was conducted with the following main aims: 1) to describe the oral health conditions and to analyse the oral health care needs and demands of 65–74-yr-olds in Hong Kong, and to propose appropriate strategies for meeting their needs in the light of societal obligations; 2) to describe the oral health conditions and to analyse the oral health care needs and demands of 35–44-yr-oIds in Hong Kong with special emphasis on assessment of changes in this age group since 1984 (when the first adult oral health survey was conducted); 3) to assess the impact of sociodemographic and dental care system factors on the oral health status of selected adult age groups: and 4) to utilize survey data to refine curriculum development and research strategies in the Faculty of Dentistry, as well as in the proposal of appropriate action to governmental committees on dental health policy. For enhanced comparability with the previous study, the 35–44-yr-olds were selected from the same geographic areas of Hong Kong Island. Multistage cluster sampling was used to recruit the study population, defined geographic units and addresses being used as the starting-point. A sample of 398 subjects was selected, of whom 93% were both interviewed and clinically examined. The 65–74-yr-olds were recruited from housing estates in all principal areas of Hong Kong, yielding a sample of 559 subjects, of whom 96% were both interviewed and clinically examined. The analysis of the data was based on the model used by the International Collaborative Study II, from which other methodologic guidance had been sought. The definitions of selected sociodemographic variables such as occupation, income, Family Material Possession Index, family support, and dental anxiety, which are relevant to the whole study, are given here.     

Dental caries in Namibia – the first national survey

Abstract This paper reports findings on dental caries in the first national survey in Namibia, the second largest country on the Southern African subcontinent. In 1991. a total of 208l individuals, representing 0.15% of the Namibian population, 764 12-yr-olds, 736 15-yr-olds and 581 35–44-yr-olds were examined to determine their oral health. Caries was diagnosed using WHO criteria by a single calibrated dentist. At 12 yr between 37% and 81% of the subjects examined were caries-free, at 15 yr between 25% and 66%, and in the age class 35–44 yr 6–44% were caries-free. Mean DMFT at 12 yr was 0.40–1.74 and at 15 yr 0.92–3.05; mean DFT at 35–44 yr was 1.36–3.93. Females had significantly more caries than males and there were significant differences between urban, peri-urban and rural areas. The caries prevalence and experience is nevertheless low and within the WHO target for the year 2000 at 12 yr of age.     

Dental caries status and treatment needs of the permanent dentition of 6–12-year-olds in Hong Kong

An oral health survey was conducted in 1986 on a representative sample of primary school children in Hong Kong. 1483 Chinese children of both sexes, aged 6-12 yr, attending 56 primary schools were surveyed. The DMFT index for the 6-yr-olds was 0.1, and for the 12-yr-olds it was 1.5. Forty percent of the 12-yr-olds were clinically caries-free. The permanent molars constituted 90% of the total caries experience of the 12-yr-olds. Over 90% of the caries lesions were found in pits and fissures. The dental caries treatment need in the permanent dentition was low and of the simple type. A great reduction in the dental caries experience of the permanent dentition of children has occurred since the introduction of water fluoridation 25 yr ago. In addition to treatment care, preventive measures should be provided by the School Dental Care Service for children with a high caries risk.     

Oral health and dental care in modern-day China

The purpose of this paper is to present salient background information on the oral care situation and organization in China and to review epidemiological literature that has been published on adults in Chinese dental journals during the last 20 years as a context for understanding ongoing oral health research activities in China. Searches were conducted through Medline as well as Chinese language catalogues and around 30 Chinese dental journals. Most oral health surveys on adults were conducted after 1970 mainly on residents living in big cities, which are also the location of major medical universities. Surveys conducted among farmers were uncommon. Dental caries and periodontal disease were the major dental diseases studied. Only a few surveys on people's oral health knowledge, attitudes and behavior were conducted. Papers concerning dental treatment needs and utilization of dental services among adults were scarce. Sample size was usually not a major problem in these surveys but the sampling methods and diagnostic criteria used were often poorly defined. Mean DMFT scores between 2 and 6 were reported in the 35-44-year-olds and between 9 and 16 in the elderly younger than 75 years. Calculus and gingivitis were reported to be common in adult Chinese; the proportion of subjects with shallow and deep periodontal pockets was not high. Complete edentulousness in the 60-69-year-olds was usually reported to be less than 10%. About 14% of the 35-44-year-olds and 19% of the 65-74-year-olds did not brush their teeth daily.     

Periodontal health status and treatment needs among the elderly

The numbers of dentate elderly are growing rapidly in all industrialized countries, and epidemiological information about their oral health is urgently needed. Our study is part of the population-based Helsinki Ageing Study (HAS), and this paper describes the periodontal health status as well as the need for periodontal treatment among the dentate elderly born in 1904, 1909, and 1914 and living in January, 1989, in Helsinki, Finland (n = 175). The dental examinations were carried out during 1990 and 1991 at the Institute of Dentistry, University of Helsinki, Finland. The subjects' periodontal health was recorded by the CPITN (Community Periodontal Index of Treatment Needs) method. The mean number of remaining teeth was 15.1 among men and 14.0 among women, with the mean number of remaining sextants 3.7 and 3.5, respectively. Healthy periodontal tissues (CPI = 0) were found in 7% of the subjects. Bleeding on probing (CPI = 1) was recorded in 6%, and calculus and/or overhanging margins of restorations (CPI = 2) in 41% of the subjects, as the worst finding. Altogether, 46% of the subjects had deep periodontal pockets, 35% with at least one 4- to 5-mm pocket (CPI = 3), and 11% with at least one ≥ 6-mm pocket (CPI = 4). Overall, 93% of the subjects required oral hygiene instruction, 87% scaling and root planing, and 11% complex periodontal treatment. The periodontal treatment need was significantly higher in men than in women; however, no significant differences were observed among the three age cohorts. The need for complex periodontal treatment was unexpectedly low, probably explained by the fact that there were many missing teeth, especially molars, perhaps lost due to poor periodontal health.     

The oral health of the elderly in Melbourne

A survey of 303 subjects over the age of 60 years collected demographic and oral health status data for analysis. The majority of the sample (64.2 per cent) were edentulous. Over 90 per cent of the dentate subjects required scaling and the removal of plaque (CPITN score of TN2); however, just less than half of the sextants examined were excluded because they contained fewer than two functional teeth. About one-third of the dentate subjects required no treatment for dental caries. Of those who required treatment, most needed only one restoration of any particular type. Total tooth loss was associated with gender, level of education, previous occupation, and birthplace. The need for complex periodontal treatment (TN3) was not high, nor was there a high prevalence of root or cervical dental caries.     

Periodontal treatment needs in populations under 20 years of age in Espoo, Finland and Chiangmai, Thailand

The aim of this study was to assess the periodontal treatment needs at under 20 yr of age in the affluent area of Espoo, Finland, offering comprehensive public dental health care, as compared to a less advantaged area in Chiangmai, Thailand. In Espoo, 50 girls and 50 boys were examined in each age group of 7, 12 and 17 yr. In Chiangmai equal numbers of girls and boys were examined to obtain a group of 89 subjects aged 18.5 + 0.6 yr. According to the Community Periodontal Index of Treatment Needs (CPITN) the need of scaling increased in Espoo from 6% of the 7-yr-olds to 39% of the 17-yr-olds. Moderate pocketing (4-5 mm) occurred in one subject at age 12 and in three subjects at age 17. In Chiangmai, deep pockets (6 mm and over) were recorded for 1%, moderate pockets for a total of 44%, and dental calculus as the highest treatment need indicator in the remaining 55%, indicating a need for professional treatment in 100% of the group examined. The mean number of sextants requiring scaling was 0.6 per person at age 17 in Espoo as compared to 4.5 at 18.5 yr of age in Chiangmai. Three or more healthy sextants per subject were recorded for 47% of the 17-yr-olds in Espoo and for only 6% of the 18.5-yr-olds in Chiangmai. It was concluded that already at young age vast differences occur between periodontal treatment needs in industrialized and developing countries.     

Periodontal conditions among the middle-aged and the elderly in Hong Kong

Abstract The aim of this study was to describe the periodontal conditions in 372 35–44-yr-old and 537 noninstitutionalized 65–74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (≥6, ≥9, and ≥12 mm, respectively). The mean numbers of teeth with loss of attachment at the ≥6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths ≥6-mm, while al the ≥9-mm threshold only 2–3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds ≥4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65–74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as “healthy” (CPI code 0) or had “bleeding only” (code 1) as their highest score. While most subjects scored CPI code 2 or 3 us their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4. Differences in the mean number of sextants affected by CPI codes between the two cohorts were mainly due to a greater number of excluded sextants in the older cohort. CPI findings for 35–44-yr-olds differed little from those reported in 1984.     

A review of the oral health status in Syria

AIM: To estimate the prevalence and severity of dental caries and periodontal diseases in Syria and to determine possible secular changes in the last two decades. METHODS: Epidemiological studies performed between 1980-1999, using the WHO criteria for dental caries and the CPITN criteria for periodontal diseases in Syria were retrieved and reviewed. RESULTS: The caries experience of 5-year-old children was high (dmft of 4.7-5.2). The estimated DMFT score of 12-year-old Syrian children was 1.9-2.3. A secular change of the caries experience in the last two decades was not apparent. The amount of untreated caries lesions was high and had not changed substantially in the last two decades. The D component comprised 72-90% of the DMFT of 12-15-year-old children and 26-30% of the DMFT of 35-44-year-old Syrians. The majority of 15-24-year-olds, and more than 80% of the 35-44-year-olds had calculus. Despite the widespread and chronic existence of calculus, only 3-11% of the 35-44-year-old persons had one or more deep periodontal pockets. CONCLUSION: The caries experience in Syria is moderately low and does not seem to have changed in the last two decades. The increased output of graduate dentists in the last decade has not changed the large amount of untreated caries lesions. In Syria, where the prevalence of unmet (caries) treatment needs is high, regular removal of calculus (scaling) for the sake of preventing periodontal pockets should not have a high priority in the oral health services.     

The Periodontal Examination Profile of General Dentists in Nova Scotia,Canada

Background: In this cross‐sectional study we investigate the extent to which general dentists in Nova Scotia carry out periodontal examinations of their patients. In addition, factors that significantly influence performing a periodontal examination by a dentist are identified. Methods: A survey questionnaire was mailed to all 443 general dentists practicing in the province of Nova Scotia in the summer of 2009. The survey included questions on demographics and the various components of the periodontal examination. Simple and multiple logistic regression tests were used to analyze the results. Results: Of the 279 (63%) responses received, 272 (61%) responses were eligible to be included in the analyses. The majority of responders (94.8%) reported performing periodontal examinations of their patients. However, only 37.8% and 43.3% of the dentists reported performing full‐mouth and selective probing depth measurements, respectively. Dentists who practiced in urban locations (P = 0.05), dentists whose practices were situated <5 km from a periodontist (P = 0.08), and dentists who planned to take a continuing education course in periodontal plastic surgery in the next 2 years (P = 0.07) were more likely to perform a periodontal examination. Conclusions: Although the majority of dentists in our study report performing periodontal examinations of their patients, only a small portion report recording complete probing depth measurements or using appropriate radiographs in their examinations. These practices could lead to an underestimation of diagnosis and treatment of periodontal disease.     

Dental health of Vietnamese Boat People on Pulau Bidong, Malaysia

Abstract – The influx of refugees from Vietnam to the industrialized countries has attracted a certain interest to studies describing the oral health status of these population groups. The present study comprises 361 refugee arriving in Malaysia from Vietnam and collected immediately at the refugee camp on Pulau Bidong. Dental caries, calculus, gingival bleeding and loss of periodontal attachment were recorded. Mean dmft increased from 1.3 for 0–2-yr-olds to 7.4 for 3–5-yr-olds. For 6–9-yr-olds mean DMFT was 2 A while it ranged between 8.5 and 10.0 for the older age groups. The frequency of secondary lesions was high for all age groups. Calculus increased consistently with age, while gingival bleeding was common even in the youngest age group. Loss of periodontal attachment greater than or equal to 6 mm was rare in all age groups except the oldest (45 yr or older). A strategy for oral health care for these population groups is discussed.     

Inequalities in prosthetic rehabilitation among elderly people: the importance of context

Giordani JMA, de Slavutzky SMB, Koltermann AP, Pattussi MP. Inequalities in prosthetic rehabilitation among elderly people: the importance of context. Community Dent Oral Epidemiol 2011; 39: 230–238. © 2010 John Wiley & Sons A/S Abstract – Objective: It has been demonstrated that social, economic, and environmental factors may influence individuals’ oral health conditions, particularly among vulnerable groups such as elderly people. The aim of this study was to investigate the association between contextual factors and the need for full dental prosthesis among elderly people. Methods: This was a cross‐sectional population‐based epidemiological study of multilevel nature, with two levels of analysis: individual and contextual (municipal). Data at the individual level were obtained from oral clinical examinations (WHO criteria) in 5349 individuals aged 65–74. Data at the contextual level were obtained from the United Nations Development Program for the 250 Brazilian municipalities participating in the survey. The outcome was the need for a full dental prosthesis for at least one arch. Exposures at the contextual level included socioeconomic, demographic, and dental service data. Data analysis used multilevel logistic regression. Results: After controlling for individual socioeconomic, demographic, and dental service variables, the chance of needing full prosthesis was higher in municipalities with lower educational levels than in better‐off ones (OR 1.57; 95% CI: 1.09–2.27) and lower in municipalities with fewer dentists (per capita) (OR 0.71; 95% CI: 0.52–0.97), compared to those with more dentists. Conclusion: This study can contribute to the identification of priority municipalities, helping healthcare authorities and communities to formulate equitable public oral healthcare policies that improve the quality of life for this population.     

Oral mucosal lesions in 65–74-year-old Hong Kong Chinese

Abstract There have been no reported surveys of oral mucosal lesions among the elderly in Asian countries. Therefore, the purpose of this study was to determine the prevalence of oral mucosal lesions among 65–74-yr-old, community-dwelling elderly Chinese in Hong Kong and to determine the prevalence of lesions in denture wearers, tobacco smokers, and alcohol drinkers. A total of 537 noninstitutionalized 65–74-yr-olds were interviewed and clinically examined in an oral health survey conducted in 1991. In the survey, the elderly underwent a systematic examination of their oral mucosa by one of the three examiners with the aid of an overhead light. The examiners were trained and calibrated before and during the survey, and a specially prepared colour atlas of oral mucosal lesions was used for lesion recognition. No mucosal lesions were detected in 64% of the elderly. In the 193 elderly subjects with lesions, 80% exhibited only one lesion. There was no difference in prevalence between men and women. The more common lesions, each being found in 5–7% of the elderly, were lingual varicosities, frictional keratosis on the buccal mucosa, denture stomatitis on the palatal mucosa, and denture-induced hyperplasia in the maxillary and mandibular buccal sulcus. Denture wearers had a higher prevalence of lesions (40%) than nonwearers (32%). There was no difference in the prevalence or number of oral mucosal lesions between those defined as users of tobacco and alcohol and those defined as nonusers in this study. No confirmed oral malignancies were found.     

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.     

Attitudes toward dentists and the dental care system among the middle-aged and the elderly in Hong Kong

Abstract A sample of 398 35–44-yr-old and 559 65–74-yr-old Hong Kong Chinese were interviewed by trained interviewers using a structured questionnaire in an oral health survey conducted in 1991. The present analysis aimed to describe the dental-care-seeking behaviour and attitudes of these subjects. It was found that 43% of the younger and 23% of the older age group had visited a dentist within the past year. More than half of the elderly and a quarter of the adults had not been to a dentist for 3 yr or more, and the main reason given by these subjects was that they felt that nothing was wrong. The vast majority of the subjects consulted a dentist only when they had toothache or other dental problems. Less than 20% of the 35–44-yr-olds visited a dentist for a check-up or teeth cleaning, and these subjects were described as having a prevention-oriented attitude toward oral care. The result of a logistic regression analysis showed that there was a higher chance for subjects to have this attitude if they had dental programme coverage, perceived their teeth to be good, had better dental health knowledge, had a more positive dental attitude, and were less anxious about dental care. However, the influence of these factors was quite weak, because the overall percentage of correct classification of the model was 83.7% and the sensitivity was only 23.3%.     

Use of dental services by the middle-aged and the elderly in Hong Kong

Abstract The objectives of this analysis were to describe the dental service use pattern of the 35–44- and 65–74-yr-old age groups and to determine to what extent this pattern could be explained by selected sociodemographic and attitudinal variables. The study populations comprised 398 35–44-yr-old and 559 65–74-yr-old Hong Kong Chinese. Use of dental services was determined on the basis of the respondents' own perception of the regularity of their dental visits and by the time since the last denial visit. The younger groups was categorized into regular users, irregular users, and nonusers, and the older group was categorized into three groups according to last dental visit (within 2 yr, 2–5-yr, 5 yr or more). A modification of the Andersen and Newman model for individual determinants of health care use was used as the framework for a logistic regression analysis. Predisposing variables were sex, education, occupation, altitudes, knowledge, preventive orientation, and dental anxiety; enabling variables were Family Possession Index, income, family support and access to a dental programme; need variables were perceived conditions of teeth, denial problems, denial pain, need for treatment, normative need for treatment, and denture wearing. In general, use of denial services was low. For the 35–44-yr-olds, the best regression model (sensitivity: 62%, specificity: 95%, overall correct classification: 88%) indicated that there was an increased probability of having a regular dental care pattern if respondents were prevention oriented, had access to a dental benefit programme, had not experienced pain, had a higher income, perceived their teeth as fair or poor, and perceived a need of treatment. For the 65–74-yr-olds, three variables remained in the final model (sensitivity: 51%, specificity: 68%, overall correct classification: 61%). Respondents who had not seen a dentist within the last 2 yr were more likely to have had pain and to know less about dental caries. As the number of teeth in need of treatment increased by 1, respondents were 1.09 times more likely not to have seen a dentist within 2 yr.