Methanogenic activity in human periodontal pocket

Samples of subgingival dental tissues were examined for the presence of methanogenic activities. Using enrichment cultures, methanogenic activities were detected in 9 of 17 individuals. A mesophilic, Gram-positive, irregular coccoid methanogen, which showed close resemblance to a Methanosarcina sp., was isolated from one sample collected from a patient with type IV periodontal pocket (the periodontal pocket is a space bounded by the tooth on one side and by ulcerated epithelium lining the soft tissue wall on the other). The isolate used methanol, methylamine, acetate, and H(2)-CO(2) as the sole source of carbon. However, the isolate was unable to use formate and trimethylamine as growth substrates. The organism had an optimum pH of 6.5 and an optimum temperature of 37 degrees C. The isolate not only used ammonia, but also used nitrate as a nitrogen source. The niche of this methanogen in periodontal pockets may be to carry out terminal oxidation of simple organic compounds such as methanol and acetate produced by other obligate anaerobes present in periodontal pockets. This methanogen may also play a vital role in interspecies hydrogen transfer, as demonstrated by its use of H(2)-CO(2) as a substrate. The isolate produced significant amount of methane in vitro.

Periodontal conditions and service utilization behaviors in a low income adult population

PURPOSE

Dental services utilization varies and access to periodontal therapy is not uniform. The objectives were to study an adult population of Medicaid eligible subjects in the Kitsap County, State of Washington, USA: (1) to assess their oral health status, specifically periodontal conditions, and (2) to assess their use of dental services and behavioral beliefs in relation to dental diseases.

MATERIALS AND METHODS

1500 randomly selected eligible households were invited to a cost-free dental examination. The Periodontal Screening and Recording (PSR) index and six bitewing x-ray films were obtained. Subjects responded to a service utilization questionnaire. A telephone interview was performed with 100 randomly selected eligible subjects to assess their behavioral beliefs about dentistry.

RESULTS

132 (8.8%) of the contacted subjects responded while only 4.5% came to the clinical examination. The mean age of the subjects was 35.0 years (S.D. +/- 13.6, range 18 to 78 years) and 73.4% were women. Bleeding on probing was found in 82.8%, and 7.8% of the subjects had teeth with suppurating gingival conditions. Supra, or sub-gingival calculus could be identified in 95.3% of the subjects. Probing depths > 5.5 mm (not accounting for surfaces of third molars) were found in 11.3%, and radiographic evidence of vertical defects > or = 3 mm in 47% of the subjects. Tooth decay in need of urgent dental care was found in 75% of the subjects. Cost (63.2%) and lack of dental insurance (51.3%) were primary factors for not seeking care but 48.7% had no desire to enroll in a "no cost" dental therapy program. Dental fear was an obstacle to care in only 2.6% of the subjects.

CONCLUSION

Primary barriers to the utilization of dental services in low income, uninsured populations were: (1) a pre-occupation with other daily issues, financial being the greatest, (2) an attitude of waiting for a problem to occur before seeking dental care, (3) that tooth extraction is the solution or only available treatment option.

The relationship between periodontal disease attributes and Helicobacter pylori infection among adults in the United States

OBJECTIVES

We investigated the relationship between Helicobacter pylori infection and abnormal periodontal conditions.

METHODS

Data from the first phase of the third National Health and Nutrition Examination Survey were used. A total of 4504 participants aged 20 to 59 years who completed a periodontal examination and tested positive for H. pylori antibodies were examined.

RESULTS

Periodontal pockets with a depth of 5 mm or more were associated with increased odds of H. pylori seropositivity (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.12, 1.94) after adjustment for sociodemographic factors. This association is comparable to the independent effects of poverty on H. pylori (OR = 1.54; 95% CI = 1.10, 2.16).

CONCLUSIONS

Poor periodontal health, characterized by advanced periodontal pockets, may be associated with H. pylori infection in adults, independent of poverty status.

[Periodontal conditions and diabetes mellitus in the Japanese-Brazilian population]

OBJECTIVE

To evaluate the relationship between diabetic status and periodontal conditions in the Japanese-Brazilian population.

METHODS

The sample consisted of 1,315 subjects, of both sexes, first (Issei) and second (Nisei) generations, aged 30 to 92 years, living in Bauru, Brazil. Edentulism and presence of 6 null sextants were the exclusion criteria for the sample. The Community Periodontal Index and Periodontal Attachment Loss Index were determined using the probing of 10 teeth in a sample of 831 subjects. The diagnosis of diabetes mellitus was based on fasting blood sugar and blood sugar 2 hours after 75 mg of glucose overload. Statistical analysis was conducted using Kappa test and Chi-square test.

RESULTS

Regarding periodontal conditions, 25.5% of the sample were healthy people, 12.5% showed bleeding on probing, 49.4% calculus, 10.4% pockets of 4-5 mm deep, and 2.2% pockets deeper than 6 mm. The percentage of subjects with an attachment loss of 0-3 mm was 24.2%; 4-5 mm, 36.7%; 6-8 mm, 23.7%; 9-11 mm, 11.3%; and up to 12 mm or more, 4.1%. The association between the periodontal condition and diabetes mellitus showed no statistical significance (p<0.05), although diabetic subjects have a higher percentage of deeper pockets and attachment loss >6 mm than non-diabetics, as tested by Chi-square test.

CONCLUSIONS

Epidemiological studies relating oral health and systemic disease, such as diabetes mellitus, can provide important contributions for preventing the worsening of such diseases.

The second national survey of oral health status of children and adults in China

OBJECTIVES

To describe the oral health status of Chinese children and adults at national level in relation to location and province and to highlight changes in dental caries experience.

DESIGN

Cross-sectional study, oral epidemiological survey based on WHO methodology, clinical examinations.

SETTING

National survey by National Committee for Oral Health.

SUBJECTS

Representative samples of provinces, districts, townships; cluster sampling including subjects aged 5,12,15,18, 35-44 and 65-74. Each age group consisted of 23,452 participants, i.e. total of 140,712 individuals.

RESULTS

At age 5, 76.6% were affected by dental caries and mean dmft was 4.5. Mean DMFT varied from 1.0 in 12-year-olds, 1.4 in 15-year-olds, 1.6 in 18-year-olds, 2.1 in 35-44-year-olds to 12.4 in 65-74-year-olds. In adults, caries experience was higher in females than in males. The effect of urbanisation on caries prevalence in children varied by province and age. Among adolescents and young adults caries levels were high in urban areas while caries experience was high for old-age people of rural areas. At national level, changes in dental caries prevalence of 12- and 15-year-olds were small. However, some provinces with extensive oral health programmes (e.g. Love Teeth Day) showed declining caries experience whereas provinces with limited preventive activities had increasing levels of caries. For all age groups, gingival bleeding and calculus were most frequent. Severe periodontal conditions were relatively rare.

CONCLUSION

The systematic implementation of preventive oral care and community-oriented health programmes are needed for the continuous promotion of oral health in China.

[Periodontal diseases in a university setting in Ivory Coast]

The aim of this study was to measure the prevalence and severity of periodontal diseases, and also to evaluate periodontal treatment needs of the students of Abidjan University, in Ivory Coast. 647 students were randomly selected and interviewed to determine age, sex and oral hygiene habits; the subjects were examined for tooth mobility, plaque, calculus, gingival bleeding, periodontal probing depths and gingival recessions. The oral hygiene was insufficient: 86.08% of the subjects presented calculus--The average of sextants presenting gingival bleeding was to 4.03 and to 3.43 for calculus. The prevalence and severity of periodontal pockets were low: only 0.36 sextants on average presented pockets of 4-5 mm and 0.025 sextants presented pockets of 6 mm or more. As concerns periodontal treatment needs, 89.64% of subjects needed oral hygiene advises, 84.85% needed scaling/root planning, and 1.39% needed complex periodontal treatment. Our findings confirm the fact that destructive periodontal disease is not an inevitable consequence of gingivitis. The information, screen, and prevention should begin reality in our daily practice.

Prevalence of periodontal pocketing and tooth mobility according to tooth types in Nigerians--a pilot study

The aim of the present study was to evaluate the occurrence of periodontal pocketing and tooth mobility according to the tooth types in the mouth. There is a paucity of knowledge concerning which tooth types are more prone to periodontal disease from the review of literature. The study sample comprised 255 subjects, age ranged 16 years to 74 years. These subjects were those referred to the Periodontology Clinic of the University College Hospital, Ibadan, Nigeria, for one form of periodontal disease or the other. All the teeth were tested for periodontal pocketing using William's periodontal probe (Astir Intermedica, Kensington, London) and for tooth mobility using the Miller's Mobility Index method. The study showed that prevalence of tooth mobility is in this descending order--lower incisors, upper incisors, upper first molars, upper second molars, lower first and second molar, the premolars and lastly, the canines with the least occurrence on the upper left canines. This order is slightly different for prevalence of periodontal pocketing. The teeth most affected by pocketing were the upper second molars, followed by upper first molars, lower second molars with the least being the canines. It is suggested that exceptional care be given to these most susceptible teeth for periodontal disease in the mouth in order to prevent the development of irreversible damage of the periodontium.

[Effect of metabolic control in type I diabetes patients and its association with periodontal disease]

OBJECTIVE

To compare the frequency of periodontal disease in type 1 diabetes mellitus patients with and without metabolic control, having a control group of healthy patients.

MATERIAL AND METHODS

A prolective cross sectional study with simple random sampling was carried out; patients were divided in three groups: A). Forty healthy subjects, B). Twenty diabetic patients with metabolic control, and C). Twenty diabetic patients without metabolic control. The diabetic subjects were evaluated with glycosylated hemoglobin (GHb) to determine the glucose control; clinical periodontal evaluations were performed for all teeth in each subject and following indexes were included: Plaque, gingival, mobility, probing depth, attachment level, bleeding on probing, and marginal bone loss.

RESULTS

The imbalance of glucose of subjects with diabetes mellitus type 1 was associated with more frequency of periodontal disease (p < 0.05).

CONCLUSION

The population of type 1 diabetes mellitus with imbalance of glucose showed association with periodontal disease.

Prevalence and risk indicators for destructive periodontal diseases in 3 urban American minority populations

BACKGROUND, AIMS

Destructive periodontal diseases have been reported disproportionately more prevalent and severe in African-Americans relative to other American populations. Differences in subgingival microbiota and host immune response have also been reported for African-Americans, implying that risk factors for disease progression may also differ for these populations. Since it is not clear whether these differences are truly genetic or due to confounding variables such as social economic status, we examined a series of clinical, environmental, demographic, and microbiologic features associated with periodontal disease status in a group of 185 urban minority subjects resident within the greater New York metropolitan area.

METHODS

The study population consisted of 56 Asian-American, 71 African-American and 58 Hispanic subjects. Clinical data recorded included pocket depth, attachment level, gingival erythema, bleeding upon probing, suppuration, and the presence of supragingival plaque. Environmental and demographic data recorded included smoking history, years resident in the United States, whether the subject reported a private dentist and occupational status. Subgingival plaque was sampled from the mesial aspect of all teeth exclusive of third molars and the levels of 40 subgingival species enumerated using checkerboard DNA-DNA hybridization.

RESULTS

The African-American group had more missing teeth, deeper periodontal pocket depth and more attachment loss than the Asian-American or Hispanic groups. However, the African-American group were less likely to report having a private dentist, had a greater proportion of smokers and a greater proportion of unskilled individuals. The profile of subgingival species differed among the three ethnic/racial groups with A. actinomycetemcomitans, N. mucosa, S. noxia and T. socranskii significantly elevated in the Asian-American group and P. micros significantly elevated in the African-American group. When subset by occupational status, numbers of missing teeth, pocket depth, attachment level and prior disease activity were all found increased in the unskilled relative to the professional group. Local factors including the mean % of sites with plaque, marginal gingival erythema, bleeding upon probing and suppuration were also elevated in the unskilled group. The microbial profile differed among the 3 occupational groups with the unskilled group having elevated numbers of species associated with destructive periodontal diseases.

CONCLUSIONS

Although greater destructive periodontal disease prevalence and severity were found in the African-American group, these results suggest that environmental and demographic variables, such as occupational status, may have a greater influence on risk indicators associated with disease prevalence and progression in these populations.

Prevalence of periodontal disease in endemically flourosed areas of Davangere Taluk, India

Success of fluoride in combating dental caries led to study of fluoride on periodontal disease, but studies are less reported in literature and results are varied in nature. To address this issue, the study was conducted to assess severity of periodontal disease among (n = 283) 36-45 years old adults residing in area of different concentration of fluoride in drinking water. The villages selected were having fluoride concentration in their drinking water are Shamnur (0.5 PPMF), Kundawada (1.1 ppmF) and Halebathi (3.17 ppm). Ion Selective Electrode Method (OrionUSA) estimated fluoride in drinking water. Community Periodontal Index (WHO, 1997) and Plaque Index (Silness and Loe, 1967) was used to assess periodontal status. There was consistent decrease in mean plaque score from 1.45+ _0.024 at 0.51 ppm, 1.21+ _0.009 at 1.1 ppm, and 1.12+ _0.08 at 3.17 ppm fluoride area. This difference was significant statistically (P < 0.001). As the fluoride concentration in drinking water increased there was decrease in severity of prevalence of periodontitis. This difference in observation was significant statistically (P < 0.05). There were no effects of fluoride on calculus, since little variability was found in three different fluoride areas. Thus it was concluded from the study results that the increase in fluoride concentration decreased the plaque accumulation. decreased the shallow and deep pockets. Hence lower prevalence and severity of periodontal disease.

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.

Dental caries prevalence, tooth brushing and periodontal status in 150 young people in Istanbul: a pilot study

OBJECTIVE

To evaluate periodontal conditions, prevalence and determination of dental caries and oral health behaviours in a group of young people in Istanbul.

DESIGN

Subjects were orally examined and questioned.

SETTING

A high school in Istanbul.

SUBJECTS

One hundred of fifty students.

RESULTS

This study showed that 28 per cent of teenagers had adequate oral hygiene. These findings suggest that 72 per cent of the subjects needed oral hygiene education and required restorative dental care.

CONCLUSIONS

The present study showed that dental treatment need is very high in the sample group. Strong co-operation should be set up between families, schools, communities, regulators and legislators in order to develop and implement comprehensive oral health promotion programmes.

Oral self-care and periodontal health indicators among adults with diabetes in Finland

We assessed the effects of oral self-care on periodontal health indicators among adults with diabetes. The sample consisted of 120 dentate individuals, all of whom were regular patients at the Salo Regional Hospital Diabetes Clinic in southwest Finland. Clinical periodontal examination included identification of visible plaque, the presence of calculus, and use of the Community Periodontal Index of Treatment Needs (CPITN). A questionnaire focused on self-treatment, self-prevention, and self-diagnosis of oral diseases, utilization of dental services, and patients' knowledge and attitudes towards oral health. The New Century model of oral health promotion was used as a theoretical framework for analysis of determinants of oral self-care. Although individuals aged 40 years or older were more frequent interdental cleaners, significantly better oral health indicators were found among younger patients. Women reported brushing their teeth more frequently, and differences in plaque and calculus indices were significantly lower than those of men. Self-reported good oral condition was strongly associated with frequent dental visits and less plaque and calculus. No missing teeth and age less than 40 years were predictors of lower plaque, calculus, and CPITN scores. A significant association was found only between frequent dental visits and reduced amount of calculus. Self-reported frequency of oral health habits among adults with diabetes seemed to have little effect on periodontal health indicators. Adults with diabetes should benefit from comprehensive oral self-care, and more attention is needed for improving the quality and outcome of these habits.

Changed oral conditions, between 1963 and 1999, in the population of the Tokelau atolls of the South Pacific

In 1999, an oral health survey was included in an assessment of the community oral health programme of the Tokelau Islands population. This provided a comparison with a similar survey in 1963. In a convenience sample of 386 children and adults, approximately 30 percent of the total population, the deciduous (number of df teeth) and permanent (number of DMF teeth) tooth scores across all age groupings were higher in 1999 compared with 1963. For 15- to 19-year-olds, the mean DMF scores were 8 and 1; and for 35- to 44-year-olds, the scores were 18 and 4 in 1999 and 1963 respectively. The prominent feature of the DMF scores for those over age 25 years was the numbers of missing (M) teeth. The mean number of M teeth at 20-24 years was 5 and 0, and at 35-44 years, 13 and 2 respectively in 1999 and 1963. Periodontal disease was endemic in adults in both surveys. A serious decline in oral health has occurred over the past 35 years.

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 (> or = 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 disease among indigenous people in the Amazon rain forest

BACKGROUND

People are not all equally susceptible to periodontitis. To understand the epidemiology and natural history of this disease, it is important to study populations with varying genetic backgrounds and environmental exposures.

AIM

Characterize the periodontal condition of a sample of indigenous adults in a remote region of the Amazon rain forest and determine the association of periodontal disease with various demographic, behavioral and environmental factors.

METHODS

A cross-sectional evaluation of 244 subjects aged 20-70 years was conducted. Pocket depth (PD), clinical attachment level (CAL), bleeding on probing (BOP), plaque and calculus were assessed for the Ramfjord index teeth.

RESULTS

These people had high levels of plaque, calculus and BOP. The mean PD was rather shallow (2.45 mm in 20-29 year-olds to 2.73 mm in 50+ year-olds) and did not increase significantly with age. Mean CAL (0.57 mm in 20-29 year-olds and 2.26 mm in 50+ year-olds) and mean location of the free gingival margin in relation to the cemento-enamel junction changed significantly with age (p<0.0001). Multivariate analysis revealed that increasing age, bleeding on probing and calculus scores were positively associated with mean CAL (p<0.01). Sex, ethnicity, level of modern acculturation, use of coca or tobacco paste, frequency of dental visits and plaque were not associated with mean CAL.

CONCLUSIONS

Periodontal disease in these people was mainly associated with gingival recession rather than deep pockets. Most people had clinical attachment loss but despite poor oral hygiene and extensive gingival inflammation, they did not have very severe periodontal destruction.

Oral health status of an indigenous adult population of Central America

OBJECTIVE

To determine the caries experience and periodontal disease status in adults of an indigenous rural community of Guatemala, and assess the suitability for longitudinal investigations.

BASIC RESEARCH DESIGN

This investigation comprised an initial screen (Study I) and a more detailed periodontal examination (Study II). In Study I, caries and gingivitis levels were determined. In Study II, pocket probing depths (PPDs) and clinical attachment levels (CALs) were recorded on all teeth excluding third molars.

CLINICAL SETTING

Tzununa, Guatemala, Central America.

PARTICIPANTS

Studies I and II were conducted in 120 adults 3 18 years and 54 adults 3 25 years respectively.

RESULTS

In both Studies I and II, tooth retention was high with a mean tooth count of 28.2 and 27.2 respectively. Extensive soft deposits and both supra- and subgingival calculus were almost universal, although gingivitis was less than expected (Study I: Mean percentage of sites bleeding on probing = 27.6). In Study I, the mean number of carious teeth was 8.6 and there was no statistically significant correlation with age. In Study II, PPD 3 5mm and CAL 3 6mm were highly prevalent (100% and 56% of subjects respectively), although widespread and severe disease was not evident.

CONCLUSIONS

Despite the high caries level and the evidence of periodontal destruction in the majority of subjects, all study subjects had a functional dentition suggesting that emergency treatment remains the current priority. Longitudinal studies in such untreated populations would provide increased understanding of the role of environmental factors in disease etiology. The study also highlighted some methodological issues pertinent to conducting studies in remote communities.

The oral cleanliness and periodontal health of UK adults in 1998

Periodontal disease continues to be a major concern for dentists and patients. This paper reports the findings of the 1998 UK Adult Dental Health survey in relation to plaque, calculus, periodontal pocketing and loss of attachment. It is apparent from this study that moderate periodontal disease remains commonplace amongst UK adults and that the associated risk factors of plaque and calculus are in abundance, even amongst those who profess to be motivated about their oral health and attend the dentist regularly. The continued high prevalence of disease needs to be seen in the context of the far larger number of people who are now potentially at some risk, particularly in the older age groups, because of improvements in tooth retention. However, the cumulative effect of disease means that control of the periodontal diseases, even mild and slowly progressing disease, will be a key issue if large numbers of teeth are to be retained into old age. If that level of control is to be achieved we need a widespread improvement in our management of the disease, particularly in our ability to improve the oral cleanliness of the UK population.

Prevalence assessment of periodontal disease in 3-6 year old children through PSR--a pilot study

Increasing amounts of information emphasise the relevance of prevention, early diagnosis and early treatment of periodontal diseases in children. Children and adolescents affected by periodontal disease, mainly those who present a fast and severe attachment loss, are considered to be at risk of developing early or advanced periodontitis. Alternatively they may be presenting a reflex of systemic conditions affecting the periodontium. This study was aimed at verifying the acceptability of the use of the Simplified PSR (Periodontal Screening and Recording) Index in a very young population since a previous study in Bahia, Brazil, indicated a very high need for periodontal treatment in adolescents and young adults. A total of 200 children aged 3-6 years from private schools in Bahia, Brazil, were examined by four trained undergraduate students. The screening system was well accepted by the subjects and the fact that it is a fast tool was considered important for the successful examination of all sextants without behavioural disturbance. A high prevalence and a low severity of parameters related to periodontal disease were found in this population. A statistically higher prevalence of PSR code 2 (61.5%) [54.50-68.49] CI 95% when compared to PSR codes 0 (23.5%) 117.93-30.10] CI 95%, 1 (14.5%) 110.07-20.32] CI 95% and 3 (0.5%) 10.02-3.18] CI 95% were shown. There was no statistically significant difference between female and male children for any PSR code. The finding of more parameters related to periodontal health in S5 when compared to sextants S6 and S4 showed statistical significance (CI 95%).

Periodontal disease status of an indigenous population of Guatemala, Central America

OBJECTIVES

This study was designed to determine the periodontal disease status of an indigenous Indian community of rural Central America (San Juan La Laguna, Guatemala), for comparison with results of similar studies in other populations, and with a view to performing future studies to address familial clustering of adult periodontitis.

METHODS & RESULTS

An initial screen of 239 subjects aged 12-75 years from extended families suggested a high disease prevalence according to full-mouth pocket probing depths (PPDs), with more than 75% of subjects with one or more pockets of PPD > or =5 mm. A more detailed study was performed in 125 unrelated subjects > or =18 years, recording full-mouth PPDs and clinical attachment levels (CALs). The high prevalence of pocketing was confirmed and 90% of adults > or =35 years had at least one site with CAL > or =6 mm. However, extensive disease was restricted to a small minority, with only 10% of adults > or =35 years having 20% or more sites with CAL > or =6 mm.

CONCLUSION

The study results highlight the importance of performing a detailed examination and appropriate analysis. In both studies, tooth retention was high (mean number of teeth recorded was 26.4 and 28.0 respectively), smoking unusual, and families large and localised to the village. This community thus affords several advantages over populations in developed countries when considering familial studies of adult periodontitis.

Prevalence of periodontal conditions among public-funded dental patients in Australia

BACKGROUND

The aims of this study were to describe periodontal health status by gender, type of care, geographic location and age and to investigate associations of these factors with tooth loss.

METHODS

In 1995-96, state and territory dental services surveyed a random sample of 6,109 public-funded patients. Dentists recorded oral health status at the initial visit of a course of care, using written instructions but without formal calibration. Periodontal status was assessed using the community periodontal index of treatment needs.

RESULTS

Prevalence of periodontal conditions among dentate patients was higher among older, male, emergency and urban patients (chi2; p<0.05). Age-specific edentulism was lower for male, emergency and urban patients (chi2; p<0.05). Numbers of missing teeth were lower for younger, non-emergency and urban patients (Anova; p<0.05). Prevalence of periodontal pockets 6mm or more was associated with gender, type of care, geographic location, age and number of missing teeth (logistic regression; p<0.05).

CONCLUSIONS

Prevalence of severe periodontal conditions was lower in 1995-96 compared with public-funded patients in 1984 and 1992-93, but prevalence of periodontal health remained lower than the general population in 1987-88. A survivor effect may result in lower recording of severe periodontal conditions among subgroups with higher tooth loss.

[Gingival and periodontal conditions associated with socioeconomic factors]

OBJECTIVE

To assess the prevalence of gingival bleeding, calculus and periodontal pockets among 18-year-old males. In addition, to verify whether these conditions are associated with years of education and family income.

METHODS

A cross sectional survey was carried out. A representative sample of 18-year-old males living in Florianópolis, Brazil, was selected from the Brazilian Army applicant list. Clinical and socioeconomic data were collected through dental examinations and interviews, respectively. Socioeconomic data included the subjects and their parents' years of education, and family income. A single dentist carried out the dental examinations looking for gingival bleedings after probing, calculus and shallow and deep periodontal pockets (3.5 mm to 5.5 mm and 5.5 mm and over). The associations between periodontal conditions and socioeconomic variables were analyzed using the qui-square test.

RESULTS

A total of 286 people participated in the study. Intra-examiner agreement was high. All kappa values were above 0.7. The prevalence of gingival bleeding, calculus, shallow and deep periodontal pockets were 86%, 50.7%, 7.7% and 0.3% respectively. There were associations between gingival bleeding and all socioeconomic variables (p<0.001). Calculus were associated with the subject's and their father's low educational level (p<0.05) and with their mother's low educational level (p<0.01). Periodontal pockets were associated with their father's low educational level (p<0.05).

CONCLUSIONS

The prevalence of periodontal pockets was very low, while gingival bleeding and calculus were high. General periodontal health of the studied population was good.

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 > or = 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.

Periodontal disease in American Indians and Alaska Natives

OBJECTIVE

The primary purpose of this paper is to provide information on the periodontal disease status of Native Americans using a variety of data sources. The impact of periodontal disease on the provision of dental care within the Indian Health Service (IHS) is also discussed.

METHODS

Four data sources were used to evaluate the periodontal disease status of Native Americans: IHS periodontal disease monitoring system (1962-78), 1984 IHS Patient Oral Health Survey, 1990 WHO community-based survey (ICS-II), and the 1991 IHS Patient Oral Health Survey.

RESULTS

There appears to be a trend toward a higher prevalence of incipient and overt periodontal disease among Native Americans over time. The prevalence of overt periodontal disease (periodontal pockets > 5.5 mm) is higher among Native American diabetic patients than nondiabetic patients (34% vs 19%).

CONCLUSIONS

Due to the variety of indices used by the IHS during the last 20 years, it is difficult to make direct comparisons of the available periodontal disease data. However, it appears that the prevalence of periodontal disease among Native Americans is increasing. Type II diabetes accounts for significant increases in periodontal disease and tooth loss in Native American populations. Certain forms of early onset periodontal disease also may pose significant threats to the oral health of Native Americans.

Periodontal conditions among the old elderly: five-year longitudinal study

In the past three decades, there has been a significant rise in the number of old elderly (85+ years old) in Finland, and more of these individuals are retaining their natural teeth. Numerous cross-sectional studies have reported on the periodontal health of the elderly (aged 75+), but very few long-term follow-ups have been reported. This study forms a part of the population-based Helsinki Aging Study (HAS) and compares the periodontal health status and the treatment needs at baseline with those of the same population five years later. The baseline study, in 1990-91, examined the dentate elderly born in 1904, 1909, and 1914, living in Helsinki, Finland (n = 196). The follow-up study was completed in 1995-96 (n = 73). Periodontal status was recorded by means of the Community Periodontal Index of Treatment Needs (CPITN) in 175 dentate subjects (55 males and 120 females) who met the criteria at baseline, and in 57 dentate elderly (17 males and 40 females), aged 81, 86, and 91 years, who remained at follow-up. Among the 57 dentate elderly who participated in both baseline and follow-up examinations, the mean number of teeth decreased from 15.9 to 15.1, and the mean number of remaining sextants from 4.2 to 3.7. There were minor changes in the periodontal health status during this five-year period, with an increase in code 2 (from 43% to 58%) and a decrease in code 3 (from 38% to 25%). Nevertheless, the overall treatment needs remained unchanged. It can be concluded that the periodontal health of the elderly had remained stable for 5 years, and almost no change was observed in their treatment needs. Therefore, periodontal disease in the elderly who are relatively healthy is not caused by the aging process.

Periodontal disease estimates in NHANES III: clinical measurement and complex sample design issues

OBJECTIVE

This paper evaluates the possibility that examiner bias or other factors contributed to an observed decline in pocket depth and gingivitis between the two three-year sequential periods of time (or phases) covered by the Third National Health and Nutrition Examination Survey (NHANES III).

METHODS

Prevalences of periodontal conditions were analyzed using data from two sets of repeat oral health examinations by examining dentists of NHANES III sample persons. The first set includes sample persons who were examined twice by the same examining dentist at an interval of one to six weeks. The second set includes sample persons who were assessed on the same day by both an examining dentist and a reference dentist. Other possible sources of error also were evaluated.

RESULTS

Overall kappa statistics measuring agreement between or within dental examiners were within the range observed for other periodontal disease surveys. While differences were found among dentists in the prevalence of pocket depth of 4 mm or more, for each group of sample persons assessed by a reference examiner-examining dentist pair, the reference examiner's periodontal measurements closely corresponded to measurements made by the examining dentists.

CONCLUSIONS

Differences between dental examiners in prevalences of periodontal conditions may be due in part to the fact that examinees were not randomly assigned to examiners. As a result, the sample persons examined by each dentist may not have been alike in characteristics thought to affect periodontal disease status. These findings suggest that the observed declines in periodontal health status between phases is not due to examiner bias. This unexplained decline may be the result of sampling variation. It is recommended that combined six-year survey results be presented whenever possible.

Plausibility of periodontal disease estimates from NHANES III

OBJECTIVES

This study investigated possible reasons for observed discrepancies in prevalence estimates and measures of association for periodontal disease between phases (1988-91 and 1991-94) of the third National Health and Nutrition Examination Survey (NHANES III).

METHODS

NHANES III data on CD-ROM were obtained from the National Center for Health Statistics. Accompanying documentation states that each phase and combined phases constitute national probability samples of the US population. Weighted estimates of prevalence (percent of persons affected) and extent (percent of sites affected) for previously reported thresholds of gingival bleeding (GB), attachment loss (AL), and probing pocket depth (PD) were generated using data from all 15,511 persons aged 13-90 years who received periodontal examinations. Odds ratios for associations between four selected risk indicators and both PD and AL were compared between phases.

RESULTS

Phase 2 estimates of GB and PD were as much as 56 percent lower than phase 1 estimates and both were different from combined-phase estimates. However, AL prevalence was consistent between phases. Prevalence differences between phases could be explained in part by examiner variations. Odds ratios for PD differed between phases by as much as one-third, although the direction and precision of associations were not affected, and differences were reduced after controlling for examiner.

CONCLUSIONS

Combined-phase estimates of GB and PD prevalence and extent differ from previously published estimates derived from Phase 1, apparently because estimates in at least one phase of the NHANES III study are biased. However, associations with selected risk indicators were fairly consistent between phases.

The possibility of previous epidemiological data to serve as baseline for future national oral health surveys--a study in Vietnam

AIM

The purpose of this paper is to review the most recent epidemiological data (1985-2000) on dental caries and periodontal diseases in Vietnam in an attempt to obtain a 'baseline' for future national oral health surveys.

METHODS

Studies on periodontal diseases and caries were included when CPITN and WHO caries criteria had been applied and when the sample size was at least n = 200 for each age group.

RESULTS

Almost all subjects had calculus. The median number of sextants with calculus in the 15-19-year- and in the 35-44-year-olds was 4.2 and 5.0, respectively. Only 2-7% of the 35-44-year-olds had one or more deep periodontal pockets. The estimated DMFT of the 12-, 15- and 35-44-year-olds was 1.8, 2.0 and 5.4, respectively, in the years around 1990.

CONCLUSION

This review shows that (often neglected) epidemiological studies from the past on caries and periodontal diseases can contain comprehensive data sets that provide an estimate of the past oral health status which may serve as a baseline for future national surveys.

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.

Epidemiology of periodontal disease: a review and clinical perspectives

The purpose of this paper is to assimilate epidemiological evidence for the prevalence of periodontal disease in human populations, and for comprehensive understanding of the disease for health care providers. Periodontal disease is a pathological condition affecting the supporting structures of teeth. It is characterised by a bacterial challenge that can instigate a destructive host response leading to periodontal attachment loss, bone loss and ultimately, possible tooth loss. The specifics of the disease process are obscured by our incomplete understanding of the role of various risk factors. Periodontal epidemiology literature lacks consistency in methodology of research, which includes various definitions for periodontal disease and health; different approaches to measuring periodontal indices of pocket depth, and attachment loss; inconsistent study designs and lack of adjustments to known risk factors. These inconsistencies do not allow for effective comparison of epidemiological studies, which is essential to find strong associations of risk factors with periodontal disease, which in turn is necessary for the interpretation of risk and causality. This paper will address several areas within the topic of periodontal disease epidemiology, including definitions of periodontal disease instituted by researchers, approaches to epidemiological studies in periodontitis, and risk factors in periodontal disease. Consideration is given to aspects of design and analyses relevant to evaluation of reports in the literature. For the clinical practitioner this review provides a theoretical framework to approach patients with comprehensive knowledge of not only the disease presentation, but also the environmental factors that govern past history, present condition and future response to treatments and interventions.

The prevalence and intraoral distribution of periodontal attachment loss in a birth cohort of 26-year-olds

BACKGROUND

Most research efforts in periodontal epidemiology have focused on middle-aged or older people, giving a picture of disease occurrence at a relatively late stage in the natural history of the condition. There is a paucity of comprehensive descriptive data from younger age groups. Understanding the epidemiology and clinical presentation of the condition earlier in the disease course may enable more appropriate interventions.

METHODS

The aim of this study was to describe the occurrence of gingival recession, probing depth, periodontal attachment loss (AL), and gingivitis among participants at age 26 in the Dunedin Multidisciplinary Health and Development Study. Gingival recession and probing depth were measured at 3 sites per tooth in 2 randomly selected contralateral quadrants.

RESULTS

At age 26, 980 (96.2%) of the surviving cohort participated and periodontal data were available for 914 individuals. Over 70% of the sample had one or more teeth with > or = 1 mm of gingival recession and it was observed at over 20% of midbuccal sites. Over 15% had 1 or more sites with probing depths of > or = 4 mm and nearly 20% had 1 or more sites with > or = 4 mm of AL. The extent of gingival recession was greatest for midbuccal sites on mandibular premolars, followed by midbuccal sites on maxillary premolars and mandibular molars. In the mandible, more distolingual sites had probing depths of > or = 4 mm, but a higher percentage of mesiobuccal sites was affected in the maxilla, and molars were the most affected, followed by premolars, incisors, and canines. Bleeding after probing was more extensive in the mandible than in the maxilla.

CONCLUSIONS

Periodontal disease appears to be well-established among a small proportion of young adults. The prevalence of gingival recession was higher than expected, with clear differences by site. Pocketing and AL were more prevalent in mesiobuccal and distolingual sites than the buccal sites, with differences between the jaws.

Oral health status and access to care in a rural area of India

A study was carried out in two villages in a rural area of Andhra Pradesh, India, 150 kilometres south of the state capital, Hyderabad. Ninety-eight women and sixty-two men, age range 15-70 years, were interviewed and examined. Information gathered included socio-economic data, distance travelled outside the village and previous access to health care. Data were recorded on periodontal status using CPITN and full periodontal charting. Comparisons were made between male and female subjects for travel outwith the village, attendance at medical and dental health facilities, tooth cleaning methods and materials and prevalence of periodontal disease. There was a high prevalence of chronic inflammatory periodontal disease in this population, and most of this was untreated. In view of the difficulties in access to health care, it would be prudent to offer good preventive oral health care within the rural community.

A 10-year prospective study of tobacco smoking and periodontal health

BACKGROUND

To date only a few studies have evaluated the long-term influence of smoking and smoking cessation on periodontal health. The present study, therefore, was undertaken with the aim to prospectively investigate the influence of smoking exposure over time on the periodontal health condition in a targeted population before and after a follow-up interval of 10 years.

METHODS

The primary study base consisted of a population of occupational musicians that was investigated the first time in 1982 and scheduled for reinvestigation in 1992 and 2002. The 1992 investigation included 101 individuals from the baseline study constituting a prospective cohort including 16 smokers, who had continued to smoke throughout the entire length of the 10-year period; 28 former smokers who had ceased smoking an average of approximately 9 years before the commencement of the baseline study; 40 non-smokers, who denied ever having smoked tobacco; and 17 individuals whose smoking pattern changed or for whom incomplete data were available. The clinical and radiographic variables used for the assessment of the periodontal health condition of the individual were frequency of periodontally diseased sites (probing depth > or =4 mm), gingival bleeding (%), and periodontal bone height (%). The oral hygiene standard was evaluated by means of a standard plaque index.

RESULTS

The changes over the 10 years with respect to frequency of diseased sites indicated an increased frequency in continuous smokers versus decreased frequencies in former smokers and non-smokers. Controlling for age and frequency of diseased sites at baseline, the 10-year change was significantly associated with smoking (P <0.001). The differences between current smokers and non-smokers, and between current and former smokers, respectively, were statistically significant (P<0.001). Moreover, the 10-year change increased significantly with increasing smoking exposure controlling for age (P= 0.01). In terms of periodontal bone height, the 10-year changes implied statistically significant reductions within current as well as former smokers (P <0.001 and P <0.05, respectively), but not within non-smokers. The overall change was significantly associated with smoking controlling for age and bone height level at baseline (P<0.01), including statistically significant differences between current smokers and non-smokers and between current and former smokers, respectively (P<0.05). Moreover, the 10-year bone height reduction increased significantly with increasing smoking exposure controlling for age (P <0.05). With regard to gingival bleeding, the 10-year differences between smoking groups were not statistically significant. Plaque index remained low throughout in all smoking groups at an overall average level of about 0.8.

CONCLUSIONS

The results suggest that periodontal health is compromised by chronic smoking as evidenced by an increase of periodontally diseased sites concomitant with loss of periodontal bone height, as compared to non-smokers whose periodontal health condition remained unaltered throughout the 10-year period of investigation. The periodontal health condition in former smokers, similar to that of non-smokers, remained stable, suggesting that smoking cessation is beneficial to periodontal health.

The change of periodontal treatment needs in a population of Ljubljana, Slovenia, over a ten year period

A follow-up study was performed to assess the change of periodontal treatment needs in the adult population of Ljubljana, Slovenia, over a ten year period. In the initial survey, conducted from 1983-1987, 1,609 dentate subjects in the range from 15-65 years of age were clinically examined. Ten years later of the 1,609 invited subjects a total 555 (34.5%) came to the oral re-examination. During the intervening period 3.1% of them had become edentulous. Periodontal treatment needs in both surveys were assessed by the Community Periodontal Index of Treatment Needs methodology. At the initial examination 2.4% of 1,609 subjects were found to be without any signs of periodontal disease, 97.6% needed oral hygiene instruction, 77.71% needed scaling and 20.3% of them needed complex periodontal treatment. Ten years later, of the 538 dentate subjects aged 25-75 years, only 0.7% of presented with healthy periodontal tissues, 99.3% needed oral hygiene instruction, 93.9% needed scaling and 27.3% needed periodontal surgery. In both surveys advanced periodontal disease in the Ljubljana population was limited to 6.0% and 8.3% of all sextants respectively. After evaluation of the population of the same age in both surveys (25-65-year-old groups) a slight decrease in subjects with healthy periodontal tissues (1.21% vs. 0.84%) was observed. In comparison, there was an increase of subjects with shallow pockets (24.8% vs. 31.1%) and a slight decrease of subjects with deep periodontal pockets (27.7% vs. 24.1%). Comparing the results we concluded that the prevalence and severity of periodontal disease in the Ljubljana population remained similar in both surveys. The findings of the present follow-up study suggest a need for more efficient primary and secondary preventive measures in order to decrease the prevalence and severity of periodontal disease in Ljubljana and Slovenia.

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%).

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.

Trends in periodontal status and oral hygiene habits in Dutch adults between 1983 and 1995

In 1995, a dental survey, similar to one carried out in 1983, was performed among persons aged 25-54 in the city of 's-Hertogenbosch, the Netherlands.

OBJECTIVE

To describe trends in adults periodontal health between 1983 and 1995.

METHODS

The participants were interviewed at home and clinically examined in a dental van.

RESULTS

Average scores for plaque, calculus, bleeding after probing and number of buccal root surfaces exposed to the oral cavity were lower in 1995 than in 1983. There was no significant change in the percentage of teeth with pocket depth of 3.5 mm or more between 1983 and 1995. No difference was found between frequency of toothbrushing in 1983 and 1995.

CONCLUSION

The results suggest that the periodontal health of Dutch adults aged 25-54 years has improved since 1983.

National pathfinder survey of periodontal status and treatment needs in The Gambia

OBJECTIVE

The aim of the pathfinder survey was to assess the periodontal status and treatment needs in The Gambia.

METHODS

A multistage stratified random sampling technique was used to obtain a sample of 1,235 (or 0.1% of the national population). The study was conducted according to the World Health Organisation's criteria (WHO, 1987). The WHO J2 software programme was used to analyse the data.

RESULTS

Not more than 12% of subjects in any age group had healthy periodontal tissues. Two to three sextants were healthy among those under the age of 35 years. Shallow (4-5 mm) pockets were present in all ages. However, less than one sextant was involved among subjects younger than 25 years. Despite the high prevalence of pockets, few sextants were edentulous. The majority of subjects needed oral hygiene instructions and oral prophylaxis. Of the subjects between the ages of 8 and 29 years, 5-28% needed complex treatment in only half of a sextant. Similarly, 38% and 80% of older subjects needed complex treatment in 0.8-1.9 sextants.

CONCLUSION

A national oral health plan in The Gambia should focus on health education and provision of oral prophylaxis by trained auxiliary health care workers. In conclusion, there is a need to develop a functional district oral health services system in The Gambia.

Periodontal status and treatment needs among Spanish hospitalized psychiatric patients

The purpose of this study was to evaluate the periodontal status and treatment needs (by CPITN) of 565 patients hospitalized in a psychiatric facility in Seville, Spain. The results of this study showed that 31.7% of the patients were edentulous and that 68.3%% were dentate. Of the dentate subjects, 8.5% were found to have a healthy periodontium, 14.2% had bleeding on probing, 43.8% had calculus, 24.6% had shallow pockets, and 8.9% had deep pockets. The results of the study also showed that the severity of periodontal disease increased significantly with age and the length of time of hospitalization. The need for oral hygiene instruction among the dentate population was determined to be 91.5%, and the need for treatment (oral prophylaxis and scaling) was 77.3%. These findings suggest that hospitalized psychiatric patients in Spain are in dire need of preventive dentistry.

Risk of severe periodontal disease in a Swedish adult population. A longitudinal study

The aim of this study was to identify risk factors for severe periodontal disease progression in a Swedish adult population between the years 1973 and 1988-91. In 1973, a random sample of 474 dentate adults living in Jönköping County was examined clinically and radiographically. A questionnaire on demographic and socio-economic status, general health, and dental care habits was also used. During the years 1988-1991, 361 of the individuals examined in 1973 were re-examined. A total of 506 (6%) teeth or in average 1.4 teeth per subject were lost between the 2 examinations. 4 subjects had become completely edentulous. The mean loss of teeth in the different age groups 20-60 years was 0.2, 0.9, 1.4, 2.3, and 2.6, respectively. The periodontal bone level decreased by age both in 1973 and in 1988 91. The mean annual progression rate was 0.06 mm for all 357 individuals and varied between 0.04 and 0.07 mm per subject in the different age groups. The presence of periodontal disease progression was defined as bone loss of >20% at a proximal site between the 2 examinations. The most prevalent tooth types with bone loss of >20% at proximal sites were the maxillary and mandibular 2nd molars and the 1st maxillary molar, representing a % of 18.0, 12.8, and 13.5, respectively. The degree of association between severe periodontal disease progression and explanatory variables was investigated using logistic regression models. The dependent variable was no progression of periodontal disease or severe periodontal disease progression, i.e., subjects with periodontal bone loss >20% at > or =6 sites. Age was found to be correlated with severe periodontal disease progression by an odds ratio of 1.05 (CI: 1.02-1.07). The frequency of females in the group with severe bone loss was 58% and higher than in the non-progressing group, 50%. Only 9% in the group with no bone loss smoked as compared to 38% in the group of individuals with severe periodontal bone loss. % supragingival plaque, gingival inflammation, and deepened periodontal pockets (> or =4 mm) at baseline were related to severe periodontal disease progression by odds ratios of 1.03 (CI: 1.02-1.05), 1.01 (1.00-1.03), and 1.03 (1.00-1.05), respectively. In the multivariate logistic regression model, age (odds ratio 1.13 (CI: 1.06-1.19)), smoking (odds ratio 20.25 (5.07-80.83)), and % pockets > or =4 mm (odds ratio 1.15 (1.04-1.27)) remained significantly associated with severe disease progression. Furthermore, female gender and differences in income level appeared in the multivariate analysis to be related with severe bone loss, with odds ratios of 3.19 (CI: 1.02-9.97) and 8.46 (CI: 1.97-36.37), respectively.

Option-4 algorithm for Florida pocket depth probe: reduction in the variance of site-specific probeable crevice depth measurements

Clinical periodontal measurement is plagued by many sources of error which result in aberrant values (outliers). This study sets out to compare probeable crevice depth measurements (PCD) selected by the option-4 algorithm against those recorded with a conventional double-pass method and to quantify any reduction in site-specific PCD variances. A single clinician recorded full-mouth PCD at 1 visit in 32 subjects (mean age 45.5 years) with moderately advanced chronic adult periodontitis. PCD was recorded over 2 passes at 6 sites per tooth with the Florida Pocket Depth Probes, a 3rd generation probe. The option-4 algorithm compared the 1st pass site-specific PCD value (PCD1) to the 2nd pass site-specific PCD value (PCD2) and, if the difference between these values was >1.00 mm, allowed the recording of a maximum of 2 further measurements (3rd and 4th pass measurements PCD3 and PCD4): 4 site-specific measure-meets were considered to be the maximum subject and tissue tolerance. The algorithm selected the 1st 2 measurements whose difference was < or = 1.00 mm (SPCD1 and SPCD2). If no 2 measurements had a difference < or = 1.00 mm, the examiner was required to select the 2 measurements closest to the rules of the algorithm. 4600 sites were available for analysis. 3992 sites (86.8%) required 2 recordings, 564 sites (12.3%) required 3 recordings and 44 sites (1%) required 4 recordings. Correlation coefficients for PCD1 and PCD2 and SPCD1 and SPCD2 were 0.83 and 0.96, respectively (p=0.00). Site-specific variances were calculated for PCD1 and PCD2 and SPCD1 and SPCD2. The mean of the PCD1/PCD2 site-specific variances (A) was 0.41 mm2 (range 0.00 mm2 to 33.62 mm2), whilst the mean of the SPCD1/SPCD2 variances (B) was 0.1 mm2 (range 0.00 mm2 to 2.0 mm2): the respective medians were 0.08 mm2 and 0.02 mm2. The study demonstrated high intra-examiner PCD agreement. The option-4 algorithm produced a reduction of 75.6% in the mean site-specific variance of PCD1/PCD2 (Y) (Y=[(A-B)/A]X 100) and a 75% reduction in the median site-specific variance of PCD1/PCD2.

Prevalence of HIV-associated periodontitis and chronic periodontitis in a southeastern US study group

OBJECTIVES

This study estimates factors associated with the prevalence of HIV-associated periodontal diseases (HIV-P) and the severity and extent of periodontitis in HIV-infected adults from North Carolina (NC).

METHODS

Data are derived from a cross-sectional study of HIV-infected adults (total n = 326, dentate n = 316) treated at the University of North Carolina Hospitals. Outcomes were a diagnosis of HIV-P and measures of probing pocket depth (PPD), recession (REC), and clinical attachment level (CAL). Immunosuppression was measured by peripheral blood CD4+ cells/mm3.

RESULTS

In addition to persons with HIV (non-AIDS), this study included 10 percent of the AIDS cases in North Carolina. Median age was 37 years (range = 19-67); 78 percent were male and 60 percent were black. Sixty-two percent of persons had a probing pocket depth > or = 5 mm; 46% had recession > or = 3 mm, and 66 percent had attachment level > or = 5 mm in one or more sites. Cases of HIV-P (n = 15) were rare. Persons taking HIV-antiretroviral medication were one-fifth (OR = 0.20; 95% CI = 0.07, 0.63) as likely to have HIV-P as those not taking those medications, controlling for CD4+ cell counts.

CONCLUSIONS

HIV-infected persons in this study group from North Carolina exhibited severe and extensive measures of adult periodontitis. A small proportion experienced a severe form of HIV-P, which was attenuated by antiretroviral therapy.

Periodontal conditions in 65-74 year old adults in France, 1995

In 1995, a study was undertaken in France to assess the periodontal health status of 603 noninstitutionalized elderly subjects aged 65-74 years. Thirty areas were identified in the Rhône-Alpes region, with a sampling method based on stratified quotas according to sex, place of residence and socio-economic group (S-EG). The CPITN index was used. The total prevalence of healthy dentate adults (n = 483) was 16.5 per cent, whilst 16.3 per cent of the adults were edentulous. The prevalence of CPITN code 1 + 2 (low) was 50.7. The higher S-EG having fewer codes 1 and 2 (45.8 per cent) than the lower S-EG (49.7 per cent) and the medium S-EG (55.7 per cent). The total prevalence of periodontal disease (code 3 + 4) was 31.5. The prevalence of periodontal disease was lower in adults of medium socio-economic status and was also lower in adults living in urban residences. Overall, 66.9 per cent of the entire population needed oral hygiene instruction, 56.6 per cent scaling and 2.3 per cent complex periodontal treatment.

Distribution of periodontal disease in a Swedish adult population 1973, 1983 and 1993

The aim of this study was to compare changes in periodontal status in a Swedish population over a period of 20 years. Cross-sectional studies were carried out in Jönköping County in 1973, 1983, and 1993. Individuals were randomly selected from the following age groups: 20, 30, 40, 50, 60, and 70 years. A total of 600 individuals were examined in 1973, 597 in 1983, and 584 in 1993. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. Based on clinical data and full mouth intra-oral radiographs, all individuals were classified into 5 groups according to the severity of the periodontal disease experience. Individuals were classified as having a healthy periodontium (group 1), gingivitis without signs of alveolar bone loss (group 2), moderate alveolar bone loss not exceeding 1/3 of the normal alveolar bone height (group 3), severe alveolar bone loss ranging between 1/3 and 2/3 of the normal alveolar bone height (group 4), or alveolar bone loss exceeding 2/3 of the normal bone height and angular bony defects and/or furcation defects (group 5). During these 20 years, the number of individuals in groups 1 and 2 increased from 49% in 1973 to 60% in 1993. In addition, there was a decrease in the number of individuals in group 3, the group with moderate periodontal bone loss. Groups 4 and 5 comprised 13% of the population and showed no change in general between 1983 and 1993. The individuals comprising these groups in 1993, however, had more teeth than those who comprised these groups in 1983; on the average, the individuals in disease group 4 had 4 more teeth and those in disease group 5, 2 more teeth per subject. In 1973, these 2 groups were considerably smaller, probably because of wider indications for tooth extractions and fewer possibilities for periodontal care which meant that many of these individuals had become edentulous and were not placed in a group. Individuals in groups 3, 4, and 5 were subdivided according to the number of surfaces (%) with gingivitis and periodontal pockets (> or =4 mm). In 1993, 20%, 42%. and 67% of the individuals in groups 3, 4, and 5 respectively were classified as diseased and in need of periodontal therapy with >20% bleeding sites and >10% sites with periodontal pockets > or =4 mm. In conclusion, an increase in the number of individuals with no marginal bone loss and a decrease in the number of individuals with moderate alveolar bone loss can be seen. The prevalence of individuals in the severe periodontal disease groups (4, 5) was unchanged during the last 10 years; however, the number of teeth per subject increased.

Radiographic periodontal findings in an elderly Finnish population

By means of panoramic radiography and additional intraoral radiographs, the occurrence of calculus, the extent of horizontal bone loss, the depth and number of infrabony pockets, the number of furcation lesions, and the number of interproximal restoration overhangs were studied in 169 dentate 76-, 81-, and 86-year-old subjects (54 male and 115 females) living at home. Alveolar bone loss (horizontal or vertical) among the participants was common, and in only 8 subjects (5%) was it judged non-existent. It was slight in 30 subjects (18%), moderate in 53 (31%), and advanced in 78 (46%). Infrabony pockets were found in 51% of the subjects and furcation lesions in 28%. The presence of calculus did not correlate with the other parameters. The number of interproximal overhangs was associated with the number of infrabony pockets and of furcation lesions (R=0.3, p<0.001 and p<0.0001) and the number of infrabony pockets with the number of furcation lesions (R=0.4, p<0.0001). Our study shows that periodontal findings are common in the dentate elderly, and associations recently found between periodontal infections and several serious diseases make radiographic examination an integral part of the oral examination of the elderly patient.