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.     

Prevalence and severity of periodontal conditions among adults in urban and rural Morogoro, Tanzania

A study to assess the prevalence and severity of periodontal conditions among 809 adults in Tanzania was carried out in 1982 in Morogoro District. The prevalence of plaque (99.6%), calculus (95.7%) and gingivitis (93.8%) among them was high. The mean number of teeth per person with pockets between 3.5 and 5.5 mm was 3.5 for the urban and 4.2 for the rural population. Pockets of more than 5.5 mm were found on average in 0.1 (urban) and 0.2 (rural) teeth per person. In the 45+ age group on average 3.0 teeth per person were missing in urban areas and 6.9 teeth in rural areas. There were no statistically significant differences found in periodontal conditions between urban and rural adults, except for the 45+ age group. In this age group a higher mean number of teeth per person with recession, calculus, pockets, gingivitis and missing were found among the rural than the urban population. The study suggests that high prevalence of plaque, calculus and gingivitis at a young age, if untreated, does not lead for all persons to severe periodontal breakdown with ultimately tooth loss in old age in this population. Effects of the study in terms of planning primary health care teaching programs have been presented.     

Significance of epidemiologic research in the understanding of periodontal disease

This review describes the development of periodonlal index systems which during the last 50 yr have made it possible to gradually expand our understanding of the etiology and pathogenesis of periodontal diseases. Modern epidemiologic research on the prevalence and severity of periodontal diseases is based on a substantial amount of scientific data collected since the early 1940's. The work of a number of innovative researchers has eventually resulted in the clarification of one unsolved problem after the other. At the same time new ideas have been developed for the inclusion of public health aspects in the epidemiologic analyses. The assessment of periodontal treatment needs has become an issue of great importance in many countries of the world and has initiated a discussion and studies on the role of the possibilities for self-assessment of treatment needs. A completely new area of interest has developed when recent epidemiologic surveys demonstrated a substantial increase in the numbers of elderly people together with a substantial increase in the number of teeth per elderly person     

Periodontal diseases in adult Kenyans

This study comprised 1131 persons who constitute a stratified random sample of the entire population aged 15-65 years in Machakos District, Kenya. Each person was examined for tooth mobility, plaque, calculus, gingival bleeding, loss of attachment and pocket depth on the mesial, buccal, distal and lingual surface of each tooth. The oral hygiene was poor with plaque on 75-95% and calculus on 10-85% of the surfaces depending on age. Irrespective of age, pockets greater than or equal to 4 mm was seen on less than 20% of the surfaces, whereas 10-85% of the surfaces had loss of attachment greater than or equal to 1 mm. The proportion of surfaces per individual with loss of attachment greater than or equal to 4 mm or greater than or equal to 7 mm, and pocket depths greater than or equal to 4 mm or greater than or equal to 7 mm, respectively, showed a pronounced skewed distribution, indicating that in each age group, a subfraction of individuals is responsible for a substantial proportion of the total periodontal breakdown. The individual teeth within the dentition also showed a marked variation in the severity of periodontal breakdown. Our findings provide additional evidence that destructive periodontal disease should not be perceived as an inevitable consequence of gingivitis which ultimately leads to considerable tooth loss. A more specific characterization of the features of periodontal breakdown in those individuals who seem particularly susceptible is therefore warranted.     

Profiles of periodontal conditions in adults measured by CPITN.

Results of almost 100 CPITN surveys in more than 50 countries for the age group 35-44 years, stored in the WHO Global Oral Data Bank as of 1 August 1990, are assembled. They are presented in the form of graphs showing the percentages of persons according to the highest score per person and arranged by country according to WHO regions. It is hoped that these overviews provide a frame of reference for the evaluation of periodontal conditions in populations and population subgroups. Calculus and shallow pocketing were the most frequently observed conditions. With a few exceptions, the percentages of persons and the mean number of sextants per person with deep pockets were small to very small. The assumed differences between industrialized and non-industrialized countries with regard to periodontal health were not reflected in the survey data examined. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before the age of 50. For the large majority in most of the populations observed, the progress of periodontal diseases seems to be compatible with the retention of a natural dentition into older age. Nevertheless, the periodontal problem is of considerable magnitude and importance, as 5-20 per cent of populations are affected by a serious, irreversible condition at the age of 40, which is a high percentage compared with almost every other disease that afflicts mankind.     

Tooth mortality and periodontal conditions in 60–80-year-old Chinese

Abstract — The study comprised 544 persons aged 60 yr or more from two urban Residential Areas and one rural village (including a nursing home) of Beijing area. Overall, the sample accounted for 81% of the total population of elderly aged 60 yr or more in the village/areas so defined. Each person was examined for dental status, plaque, calculus, gingivitis, loss of attachment, pocket depth and tooth mobility. Edentulousness was seen in 0–29% of trie persons examined, depending on age and sex. The mean number of teeth present ranged from 6.9 to 23.9, depending on age, sex, and area. The oral hygiene was poor; approximately 50% of all surfaces had immediately visible plaque deposits and calculus. About 50% of the surfaces had a loss of attachment ≥4 mm, while less than 15% presented pockets ≥4 mm. More than 50% of the individuals had loss of attachment ≥4 mm on more than 40% of their surfaces. The proportion of surfaces per person with loss of attachment ≥7 mm; and pockets ≥4 mm, respectively, showed a pronounced skewed distribution. These findings indicate that a subfraction of individuals is responsible for a substantial proportion of the severe periodontal breakdown leading to loss of teeth. This, in turn, raises important questions as to the most appropriate strategies for the prevention and control of periodontal diseases for the Chinese population.     

Periodontal conditions in 35–44-year-old factory workers in Shanghai

Abstract A periodontal survey applying CPITN was carried out in almost 500 male and female factory workers, 35–44 yr of age, in Shanghai, P.R. China. Calculus and shallow pockets were most frequent. Deep pockets of 6 mm and over were seldom found. The mean number of missing teeth was only 2.7 (out of 32). Problems associated with third molars seem to provide the largest immediate oral health problem     

Application of the Periodontal Treatment Need System (PTNS) in a group of young Israeli adults

The Periodontal Treatment Need System (PTNS) was applied to a group of young Israeli adults, 18-25 years of age, to test the system in the field. A total of 830 persons were examined. Their periodontal treatment needs were assessed. One of the aspects investigated was that of treatment needs according to distribution by sex. Only 2.7% of young adults studied were free of plaque, calculus and gingival inflammation. All the rest (97.3%) needed some kind of periodontal treatment. The time required for treatment needed was also calculated. It was found that on the average 2.4 h per person would be required to deliver the periodontal treatment needs of the group. A close association between sex and PTNS was established in this study.     

Periodontal disease prevalence in different age groups in Japan as assessed according to the CPITN

A CPITN survey was conducted involving 12,832 Japanese subjects from 7 to 64 years of age. Subjects under 18 were schoolchildren, and 18-year-old and older subjects represented various social backgrounds, having been randomly selected from both urban and rural Japan. Fifty percent of the 7-yr-old children had signs of periodontal disease, and this percentage increased with increasing age. In those under 14, this increase in periodontal disease was mainly due to an increase in the proportion of children developing dental calculus. Subjects with 6 mm or deeper pockets were observed starting from the 20-29-yr-old age group. In subjects over this age, the prevalence of periodontal disease was higher in men than in women. The percentages of subjects having pathologic pockets had increased remarkably in the 30-44-yr-olds. In the 45-64-yr-old group, almost all subjects had some sign of periodontal disease, and the percentage of those with 4 or 5 mm pockets and 6 mm or deeper pockets were 37% and 21%, respectively.     

An epidemiologic survey of oral health in Swaziland

An epidemiologic survey of oral health was conducted on 480 schoolchildren and 400 adults in Swaziland. Age groups 7, 14, 20-24 and 35-44 were selected, and nine sampling sites were chosen in various parts of the country. Oral hygiene was generally poor, visible soft deposits being prevalent in all age groups and calculus in adults. Advanced periodontal disease was present in most people over 35 years of age, and intense gingivitis was widespread in all age groups. Dental caries was found to be a common problem, affecting practically every person, in many cases quite severely. There was a tendency towards accumulation of the disease in children. Some geographic variation was found in the prevalence and severity of dental caries and periodontal disease. An additional sample of privileged children was examined, and among these children 14-year-olds showed significantly higher DMFS values than their age mates in the rest of the country. Tooth defects, including fluorosis, and oral mucosal diseases did not seem to constitute severe problems of oral health in Swaziland. On the basis of these data a public dental health program has been initiated which emphasizes prevention.     

The natural history and clinical course of calculus formation in man

This paper describes levels and progression of supra- and subgingival calculus undisturbed by active professional intervention or home care between 1970 and 1985 in Sri Lanka, or when removed at regular intervals between 1969 and 1988 in Norway. In the Sri Lankan tea laborers, both supra- and subgingival calculus formation started before age 14 years. At 40 years of age, all participants and almost all teeth and tooth surfaces had calculus. Tea laborers who both smoked tobacco and chewed betel had significantly higher calculus scores than those who only had one of these habits, and those who neither chewed nor smoked had the lowest calculus scores. Teeth with calculus showed a significantly higher rate of loss of attachment than teeth that remained calculus free. For the Norwegians who had enjoyed regular dental care throughout their lives, supragingival calculus did not increase in frequency from adolescence to the forties. Approximately 70% of the interproximal surfaces were calculus free after 40-50 years of age. Subgingival calculus scores, although low, showed some increase with longer times of exposure. On average, each person had 0.4 interproximal surfaces with subgingival calculus as they approached 50 years of age. In this Norwegian population, subgingival calculus had no impact on loss of attachment.     

Gradients in periodontal status in Japanese employed males

AIM: The objective was to assess whether there was a social gradient in periodontal status by job classification in Japanese male workers. MATERIAL AND METHODS: Study participants were 15,803 Japanese male workers aged 20-69 years. There were seven groups classified by jobs. Oral examinations were conducted using community periodontal index (CPI). RESULTS: The percentages of sextants with a CPI score of 3 or 4 of professionals were significantly lower than for other job classes. The gradient also existed for the percentage of sextants with CPI score 4. After adjusting for age, a history of diabetes mellitus and smoking status, those lower on the gradient, namely, drivers, service occupations, salespersons and managers were 2.0, 1.5, 1.4 and 1.4, times, respectively more likely to have one or more sextants with CPI score 3 or 4 compared with professionals. Odds ratios of having more than one or more sextants with CPI score 4 after adjusting for age, clinical history of diabetes mellitus and smoking status for drivers, service occupations, salespersons and managers were 2.1, 1.5, 1.5 and 1.2, respectively, compared with professionals. CONCLUSIONS: There was a gradient in periodontal status by job classification. Professional and office workers had better periodontal status than salespersons, service occupations and drivers.     

Periodontal bone loss in the aging beagle dog A radiographic study

Studies in the beagle dog have clearly established the usefulness of this breed in periodontal disease research. However, little is known about the progressive nature of the disease with advancing age. It is the purpose of this paper to describe frequency and distribution of radiographically detectable lesions in an aging population of 166 colony dogs. 3 grades of alveolar bone loss were determined on high-quality postmortem radiographs. The number of teeth involved was similar in male and female and was age-dependent. Disease was more frequent in the maxillary arcades, with the 2nd upper premolar most frequently involved. Most extensive bone loss was noted around the 3rd and 4th upper premolars, and 1st and 2nd lower molars. It is felt that by the study of such a large group of older colony dogs, a better understanding can be gained of the expected alveolar bone loss with age as determined radiographically.     

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.     

A baseline study of periodontal conditions among youths and adults in Portugal

A study was undertaken in 1979 to obtain baseline data of periodontal disease and treatment needs among rural and urban Portuguese. From Montemor-o-Novo, Alentejo and from Lisbon, 255 persons (121 males, 134 females) aged 15-44 yr were selected by a stratified quota sampling method and examined under field conditions using both Russell's Periodontal Index (P.I.), slightly modified, and components of a proposed new WHO method. The latter formed the basis for estimation of treatment need according to the Community Periodontal Index for Treatment Needs (CPITN). Periodontal disease as assessed by the P.I. exhibited epidemiologic characteristics which in several respects were similar to those reported in other populations. Severity increased with increasing age and there were trends towards more severe disease in males than in females, and more severe disease in rural than in urban districts. Relatively few cases of advanced periodontitis were detected by the P.I. as applied in this study. The underestimation of disease prevalence inherent in the scoring method, the high tooth mortality and the fact that only relatively young individuals were studied may have contributed to this finding. Great need for various types of periodontal therapy were found through CPITN assessments. However, relatively few individuals were in need of "complex periodontal therapy" as assessed by the CPITN.     

A community-based epidemiological study of periodontal disease in Keelung, Taiwan: a model from Keelung community-based integrated screening programme (KCIS No. 18)

AIMS: To estimate the prevalence and severity of periodontal disease (PD) in the Taiwanese population aged 35-44 years and to investigate the association between demographic factors and PD. MATERIALS AND METHODS: Between 2003 and 2005, residents of Keelung of the appropriate age were invited to screening. The community periodontal index (CPI) and loss of attachment (LA) index were used to measure the periodontal status at subject (prevalence) and sextant levels (severity). Basic demographic information was also collected by a questionnaire. RESULTS: Of 8462 enrollees, 94.8% had some signs of PD, of whom 29.7% had periodontal pockets >3 mm and 35% LA >3 mm. Calculus was the most common problem in terms of both prevalence (49.6%) and severity (affecting an average of 3.0 sextants per person). Risk factors for poor periodontal status (as measured by CPI) were older age (odds ratio, OR: 1.44), male gender (OR: 2.70), low education level (OR: 1.40), and being a manual worker (OR: 1.51). Similar findings were observed for LA. CONCLUSION: The prevalence of PD in 35-44-year-olds was found to be high in this large community-based study of screening for PD with CPI and LA. Poorer periodontal health was observed in males, the less educated, and manual workers.     

Assessing the dental treatment needs of an adult Israeli military population

The dental treatment needs of an adult population (career army personnel, Israeli Defence Forces, aged 20 to 46) were determined. A method is described for quantitating total restorative, endodontic, oral surgical, periodontal, and prosthetic treatment needs. The amount, and in some categories the complexity, of treatment required per person increased in proportion to age. The estimated time required per adult (all ages) to complete all dental treatments was approximately 10.5 h, including 1 h for dental hygiene therapy. These data permit calculation of cost and professional personnel needed to treat this population.     

Periodontal conditions in Europe

The aim of the present overview is to evaluate the periodontal conditions in European populations. Study was made of a number of extensive surveys of periodontal diseases carried out in a number of European countries, primarily North West Europe. These surveys often provide considerable detail. However, international comparisons are difficult to perform because of the different methods applied. Therefore, the latest overviews of results of periodontal surveys, based on the CPITN method and stored in the WHO Global Oral Data Bank, are given for the age groups 15-19 years and 35-44 years. Based on this approach, the conclusions are as follows. Trends and prevalences in periodontal health and disease in Europe are clear, at least up to the age of 60 year. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before age 50 and certainly not a major cause of edentulousness before age 60. For a large majority, in most of the populations observed, the progress of periodontal destruction seems to be compatible with the retention of a natural, functioning dentition into older age. However, the periodontal problem might still be of considerable magnitude and importance as bleeding on probing is widely encountered in the younger age groups. Furthermore, 5-15% of populations affected by a serious, irreversible condition at age 40 years is high, compared with most other diseases.     

Profiles of periodontal conditions in older age cohorts, measured by CPITN.

Results of more than 80 CPITN surveys from almost 30 countries for the age groups of 45 years and above are assembled. In this first overview, data for the older age cohorts are presented, showing the percentages of persons according to the highest score per person and the mean numbers of sextants affected per person. Results for three age groups are presented: 45-54, 55-64 and 65-74 years, with two additional surveys in older persons. There were marked variations in periodontal conditions between surveys. The assumed differences between industrialized and non-industrialized countries with regard to periodontal diseases did not show in the data examined. Also, the expected increase in periodontal destruction with increasing age was not reflected in values for pocketing or deep pocketing in the successive age groups. Some variations between surveys was also noted for the rate of tooth loss, expressed in the mean number of excluded CPITN sextants. However, on average, at age 50, almost one sextant was excluded, increasing to 1.5 sextants at 60 and almost 2.5 sextants at age 70. It is therefore suggested that the progress of periodontal destruction with age is not shown in an increase in periodontal CPITN scores, but in increased tooth loss, specified by an increasing number of excluded CPITN sextants. For the age group 65-74 years, this results in, on average, almost half of all sextants being excluded. Of the remaining sextants, approximately half had shallow and/or deep pockets.     

The predominant cultivable microbiota of crevicular epithelial cells

The purpose of the present investigation was to compare the composition of the predominant cultivable microbiota associated with gingival crevicular epithelial cells with that of the unattached microbiota recovered from the same site. Samples were taken from 2 diseased sites from 8 periodontal patients, by scraping the epithelial lining of the pocket with a curette. The epithelial cells were separated from the unattached subgingival bacteria by centrifugation in a reduced 50% Percoll density gradient. Epithelial cells formed a band at the top of the gradient and were removed separately from the unattached bacteria located at the base. Each layer was dispersed, diluted and plated on Trypticase soy agar with 5% sheep blood and 50 isolates were characterized from each sample. The microorganisms associated with the epithelial layer harbored 5- to 20-fold higher mean percentages of Bacteroides gingivalis, Bacteroides intermedius and Peptostreptococcus micros. The layer of unattached organisms exhibited 4- to 10-fold higher mean percentages of Streptococcus uberis, Capnocytophaga ochracea, Eikenella corrodens and Veillonella parvula.