Community periodontal index and treatment needs values (CPITN) in a factory worker group in Cluj-Napoca, Romania

The aim of the study was to determine the prevalence of periodontal disease and the treatment needs in a population of 214 factory workers in Romania. Of those examined, 9.34 per cent were in periodontal health (code 0), 21.49 per cent had gingival bleeding (code 1), 18.69 per cent had supra- or subgingival calculus (code 2), 32.71 per cent presented with pathological pockets 4-5 mm deep (code 3) and 17.76 per cent had pathological pockets 6 mm or deeper (code 4). The distribution of these subjects among the treatment need categories revealed that 30.83 per cent would need improvement in personal oral hygiene (I), 51.40 per cent from the subjects would need treatment (I) + scaling (II) and 17.76 per cent would need treatment (I + II) + complex treatment (III).

Periodontal conditions and treatment needs, by CPITN, in the 35-44 and 65-74 year-old population in Santiago, Chile

A CPITN survey involving Chileans aged 35-44 and 65-74 was conducted. A random, stratified sample by age, gender, socio-economic status and educational level was obtained, comprising 1150 individuals. Prevalence of chronic inflammatory periodontal disease (Codes 3 + 4) was 90.89 per cent in subjects aged 35-44, and 100 per cent in subjects aged 65-74. The total prevalence for both age cohorts was 92.19 per cent. Prevalence of periodontal disease was slightly lower in females but severity was significantly higher in males. A significant association between socio-economic status and periodontal health was found. Prevalence (Code 3 + 4) was 56.44 per cent in subjects of high, 98 per cent in subjects of middle, and 100 per cent in subjects of low socio-economic status. Also, the mean number of sextants with pockets > 6 mm (1.12) and mean number of excluded sextants (1.43) were significantly higher in subjects of low socio-economic status. An association between educational level and periodontal health was apparent. The only subjects who were periodontally healthy were in the group with university education. Prevalence of CITN (Code 3 + 4) was also significantly lower in subjects with university education. There was also a significant association between educational level and loss of teeth. Concerning missing teeth, 22 per cent were lost due to periodontal disease and 77 per cent due to caries. The prevalence of periodontal disease found in this adult representative Chilean population indicates that the entire population needs oral hygiene instruction and scaling, and that 45.70 per cent need complex periodontal treatment.

Analysis of epidemiological data on oral diseases in Nepal and the need for a national oral health survey

This paper reviews and analyses the results of epidemiological studies on periodontal diseases and dental caries in Nepal and considers the need for additional data on oral diseases for the planning of a national oral health strategy. Almost all subjects aged 12 to 19 years (68-97 per cent) and 35 to 44 years (93-100 per cent) had calculus. The various studies showed that a median 29 per cent of subjects aged 35-44 years had deep periodontal pockets. According to this estimate it can tentatively be concluded that Nepal belongs to the 15 per cent of countries in the world where periodontal conditions of the population are among the worst. An accurate DMFT-value for different age groups at present cannot be estimated due to period and sampling effects. The observed cohort effect over time suggests that caries has increased in the 12-19 years age group in Nepal in the period 1980-1996. The estimated range of DMFT-values for 12 years old children is between 0.6-1.9 and for 35 to 44 years old persons between 2.5-4.0. With these DMFT-values Nepal belongs to the countries with a 'low to very low' caries experience according to the WHO decay rating. The present epidemiological data do not justify a claim for a national oral health survey as a starting point for a national plan of oral health since more accurate data do not add additional value to that planning, particularly not in poor countries as Nepal where the oral health service is still in its infancy.

Periodontal diseases in the United States population

Recent epidemiologic surveys and studies have provided important information on the prevalence, extent, and severity of periodontal diseases in the United States. Over 50% of adults had gingivitis on an average of 3 to 4 teeth. Subgingival calculus was present in 67% of the population. Adult periodontitis, measured by the presence of periodontal pockets > or = 4 mm, was found in about 30% of the population on an average of 3 to 4 teeth. Severe pockets > or = 6 mm were found in less than 5% of the population. Attachment loss > or = 3 mm was found in 40% of the population. Gingival recession accounted for a significant amount of attachment loss. The prevalence of early-onset periodontitis ranged from less than 1% in 14- to 17-year-olds to 3.6% in young adults aged 18 to 34. Extensive and severe periodontitis was much more prevalent in minorities, people with less than a high school education, and those who had seen a dentist infrequently and had subgingival calculus. Smoking and diabetes have been identified as risk factors, especially diabetics with poor metabolic control, a long duration of the disease, and extensive subgingival calculus. Under managed care, there has been an expansion of soft tissue management programs in the offices of general dentists and referral guidelines which limit referral of patients with moderate periodontitis. Quality-assurance mechanisms will be essential for the diagnosis and treatment of persons with periodontitis.

Two-year incidence of tooth loss among South Australians aged 60+ years

Tooth loss diminishes oral function and quality of life, and national health targets aim to reduce population levels of tooth loss.

OBJECTIVES

The purpose of this study was to determine tooth loss incidence and predictors of tooth loss among older adults in South Australia.

METHODS

Data were obtained from a cohort study of a stratified random sample of community-dwelling dentate people aged 60+ years. Interviews and oral examinations were conducted among 911 individuals at baseline and among 693 of them (76.1%) 2 years later. Incidence rates and relative risks were calculated for population subgroups and multivariate logistic regression was used to construct risk prediction models. A method was developed to calculate 95% confidence intervals (95% CI) for relative risks (RR) from logistic regression models using a Taylor series approximation.

RESULTS

Some 19.5% (95% CI = 15.4-23.6%) of people lost one or more teeth during the 2 years. Men, people with a recent extraction, people who brushed their teeth infrequently, smokers and people born outside Australia had significantly (P < 0.05) greater risk of tooth loss. Baseline clinical predictors of tooth loss included more missing teeth, retained roots, decayed root surfaces, periodontal pockets and periodontal recession. In a multivariate model that controlled for baseline clinical predictors, former smokers (RR = 2.55, 95% CI = 1.48-4.40) and current smokers (RR = 2.06, 95% CI = 0.92-4.62) had similarly elevated risks of tooth loss compared with non-smokers.

CONCLUSIONS

The findings from this population suggest that a history of smoking contributes to tooth loss through mechanisms in addition to clinical disease processes alone.

A 10-year study of the progression of destructive periodontal disease in adult and elderly Chinese

This study describes the progression of destructive periodontal disease among Chinese aged 20 to 80 with limited access to dental health facilities and minimal traditions for oral hygiene procedures. These individuals were followed for 10 years to determine whether the rates for progression of periodontal disease were markedly different than for populations with more access to oral health care. At baseline, participants had been examined for tooth mobility, plaque, calculus, gingival conditions, attachment levels, and probing depths on 4 sites of each tooth present. These probing depth and attachment level recordings were repeated at follow-up, although third molars were excluded from examination. A total of 398 persons remained dentate at follow-up. The analysis demonstrated that virtually all subjects experienced > or = 2 mm attachment loss over the 10-year period, and frequently in a large proportion of the sites present. Attachment loss > or = 3 mm was also widespread, but the distribution of persons according to the extent of > or = 3 mm attachment loss was positively skewed in all age groups. Positive skewness was even more pronounced when attachment loss of > or = 4 mm was considered. Some types of teeth, such as mandibular incisors and maxillary molars, had higher progression rates than did, for example, maxillary incisors. The mean individual attachment loss rates did not differ significantly between age groups, and were remarkably similar to those reported for populations whose access to and tradition for oral health care is widespread.

Periodontal conditions in 35-44-yr-old adults in France, 1993

A national study was carried out in France in 1993 to assess the periodontal status of the population aged 35-44 yr. The study took part in the Second International Collaborative Study of Oral Health Outcomes developed and coordinated by the World Health Organization. The representative sample was composed of 1000 subjects. The Community Periodontal Index of Treatment Needs (CPITN) index was used. Gingivitis prevalence was high (80.4%) while 26.6% of dentate subjects had shallow pockets (4-5 mm). Deep pockets (> 6 mm) were rare (1.6%) concerning on average 0.1 sextant per subject; 87.5% of the 994 dentate adults needed periodontal treatment. Oral health education and scaling should reduce periodontal pathology in this population group.

Dental health and dental treatment needs among recruits of the Finnish Defence Forces, 1919-91

The first two surveys of the dental health of young Finnish men were conducted in 1919 and 1965. The objective of four subsequent surveys (1976, 1981, 1986, and 1991) was to collect both interview and clinical examination data for the monitoring of changes in the oral health status of the recruits. A significant reduction in self-reported toothache, gingival bleeding, and number of decayed teeth was observed from 1976 to 1991. At examination, the numbers of decayed teeth, teeth indicated for extraction, teeth in need of fillings, and missing teeth decreased substantially, as did the teeth with visible plaque, subgingival calculus, and teeth with 4-mm or deeper periodontal pockets. This comprehensive series of successive cross-sectional oral health surveys clearly shows that since 1976 a significant decrease in oral disease and treatment needs has taken place among the Finnish population of young men.

Oral disease, impairment, and illness: congruence between clinical and questionnaire findings

In 1992 a questionnaire was sent to 50-year-olds in two Swedish counties. These self-report data were compared with clinical observations with regard to number of teeth, removable dentures, caries, and periodontitis. Complete information from both data sources was obtained for 1041 persons. The relevant questionnaire item explained 71% of the missing tooth variance. An agreement of 0.91 (Cohen's kappa) was obtained for removable dentures. A question about problems in opening the mouth differentiated clearly with regard to measured mouth opening ability. Toothache and tooth sensitivity were reported with 95% probability when having 22 decayed teeth and with 46% when there were no decayed teeth (58% correctly predicted). Two teeth with pockets > or = 6 mm gave 5% probability and 22 such teeth gave 39% probability of reporting migration of front teeth. The main conclusion from this study is that there is good correspondence between subjective self-reports and clinical findings, especially for those conditions that are relatively easy for the patient to observe, such as the number of teeth and the presence of dentures. Thus questionnaire data can be used for information and screening about some well-defined oral conditions.

Caries prevalence and periodontal treatment needs in public and private school pupils in Jordan

A total of 886 pupils aged 15-16 years selected from 20 public and 10 private schools in northern Jordan were investigated for frequency of toothbrushing and sweet consumption, dental caries and periodontal treatment needs. A questionnaire and clinical examination were used utilising decayed-missing-filled teeth (DMFT) code and the Community Periodontal Index of Treatment Needs (CPITN), respectively. Results revealed that 35.5 per cent of public and 57.1 per cent of private school pupils reported to brush their teeth regularly while the majority of them frequently consumed sweets. There were slight differences in caries experience amongst public and private school pupils, as measured by DMFT (4.74: 4.95). While bleeding and calculus scores were prevalent in pupils of both types of schools, they were slightly higher in pupils of public schools than those in private schools. Both shallow and deep pathological pockets were found in fewer numbers (6.09 per cent) in pupils in public schools only. Oral hygiene instruction and scaling were the predominant periodontal treatment needs in both types of schools. However, the treatment needed by pupils in public schools was higher than those in private schools. Complex treatment was rarely needed by public school pupils only.

Localized juvenile periodontitis and Actinobacillus actinomycetemcomitans in a Brazilian population

Localized juvenile periodontitis (LJP) has been used as a model for studying periodontal disease, and its prevalence is considered to be higher in third-world countries (0.3-8%) than in industrialized countries (0.1%). Mostly, the disease has been associated with Actinobacillus actinomycetemcomitans (A.a.) but lack of association has also been reported. The aim of this study was to identify LJP patients in geographically different Brazilian populations and assess the presence of A.a. in their periodontal lesions. 7843 children, 12-19-years of age, from the cities of Rio de Janeiro, Votorantim and Belo Horizonte were screened, and LJP patients were identified by strict clinical and radiographical criteria. A final LJP prevalence of 0.3%, with a 99% confidence interval between 0.16% to 0.47%, was found. The prevalence in the subpopulations varied between 0.1-1.1% in the different areas. Subgingival bacterial samples were obtained from the oral cavity of 25 patients and their family members. 80% of these patients, 39.5% of their family members, 35.3% of their parents, and 43.9% of all siblings were culture positive for A.a. All but one of the families had at least one member in addition to the patient who was culture positive for A.a. In 3 families, > 1 member showed radiographic and clinical signs of LJP. 30% of non-LJP subjects coming from one of the areas with higher LJP prevalence harbored A.a. We conclude that LJP is highly associated with A.a. in this Brazilian population.

Oral health in alcohol misusers

One hundred and seven chronic alcohol misusers (mean age 42.9 years; range 21-65 years; 80 males) attending four centres in South East London were interviewed on their current and past alcohol consumption. Their nutritional status (body mass index (BMI) and mid arm muscle circumference) was also recorded. Each subject completed a dental and oral mucosal examination. Ninety four per cent of the sample consumed greater than 50 units of alcohol per week and 80 per cent greater than 100 units of alcohol per week. Smoking and alcohol misuse were found to be related, 81 per cent reporting both habits. Neither plaque index scores or mean subject pocket depths were correlated with alcohol consumption but both were positively correlated with the frequency and duration of smoking. Overall mean DMFT was 15.4; age specific mean DMFT and tooth loss of the sample were closely similar to the 1988 United Kingdom adult dental health survey data. The prevalence and severity of tooth wear and attrition were greater in the sample than levels described in the literature and these dental features may prove useful markers to the practitioner. Trauma to teeth and oral mucosae was noted in 25 per cent of the sample. Seven oral mucosal lesions (including one treated carcinoma) were detected; mucosal trauma could have acted as a co-factor. Furthermore, 21 per cent of the alcoholics were malnourished (BMI < 20). It is concluded that, unlike several reports from the United States, dental health in this sample of alcoholics is not compromised; however mucosal health is a cause for concern.

Caries prevalence and associated predisposing conditions in recently hospitalized elderly persons

The prevalence of caries and caries risk factors was studied among 120 consecutively hospitalized elderly persons. Coronal caries was recorded using the WHO criteria, and active and inactive root caries in accordance with Fejerskov et al. The CPITN was used to evaluate the periodontal state and plaque accumulation in accordance with Löe & Silness. Of the 1212 teeth examined 5% had active coronal caries (2% inactive), 14% active root caries (2% inactive), and 10% fillings with recurrent caries. No relationship was found between caries prevalence, degree of dependence, number of medicaments, age, and gender. Patients with psychiatric diseases had increased caries prevalence (P < 0.01), and lower caries prevalence was associated with frequent tooth brushing (P < 0.05). At the tooth level root caries was associated with high plaque scores (P < 0.001), degree of gingival recession (P < 0.001), presence of coronal caries (P < 0.001), and increased pocket depth (P < 0.01). The results strongly indicate that oral hygiene measures should be introduced immediately after hospitalization of these patients.

Consequences of success: do more teeth translate into more disease and utilization?

OBJECTIVES

Increased tooth retention coupled with increased numbers of older adults means that the actual number of teeth at risk to dental disease will increase sharply. Whether this increase in the number of teeth will translate into more disease and utilization in unknown. The purpose of this study was to test this "more teeth, therefore more dental disease" theory using cross-sectional data.

METHODS

In-home personal interview and oral examination data were obtained on a probability sample of elders aged 70 years and older living in the six New England states using the Medicare beneficiary list as a sampling frame. Data on dental utilization, number of teeth, dental caries, and periodontal disease were included in the current analysis.

RESULTS

Analysis of variance on subjects with 1-10 (Group 1), 11-24 (Group 2), and 25-32 (Group 3) teeth show that the extent of bleeding on probing, pocket depth, and loss of attachment all increase as numbers of teeth increase. Similarly, a greater number of restored coronal and root surfaces were found in Group 3 relative to the other two groups. Mean numbers of decayed and filled coronal surfaces were 8.4 in Group 1.33.0 in Group 2, and 50.3 in Group 3. In contrast, unrestored coronal and root surface were significantly higher in Group 1 (mean root DS = 1.3) than Group 3 (mean root DS = 0.3). Utilization patterns of those with successful aging dentitions (Group 3) show that they are visiting dentists more frequently than the compromised group (Group 1).

CONCLUSIONS

These cross-sectional data obtained from a probability sample of New England elders show that subjects who retained higher numbers of teeth have more periodontal disease and dental caries experience, and visit the dentist more frequently.

Periodontal status among male industrial workers in southern Finland with or without access to subsidized dental care

The association between subsidized dental care and periodontal status was studied in male industrial workers in southern Finland in 1994. Clinical examinations and a multiple-choice questionnaire were completed for 325 workers (age, 38-65 years) with access to subsidized dental care and 174 controls without access. The CPITN scores based on full-mouth recordings were analyzed, using both the individual and sextant as units of analysis. Overall, 6% of the subsidized group and 2% of the control group had no periodontal treatment need (p < 0.05). Deep pockets > or = 6 mm were found in 5% of the subsidized workers and 11% of the controls (p < 0.05). In the logistic regression analyses the probability of calculus was negatively associated with access to subsidized dental care. Smoking was the strongest independent factor affecting periodontal status. Our findings show a positive relationship between access to subsidized dental care and periodontal status.

Periodontal status of a subject sample of Yemen

From August to October 1991, the periodontal status of 1001 Yemenis representing the age groups 12-14, 15-19, 20-24 and 35-44 years was recorded and evaluated with reference to the CPITN, the calculus index and clinical attachment levels. The impact of chewing khat, the leaves of a cultivated, alkaloid shrub, and of using the traditional miswak chewing stick for oral hygiene purposes were investigated. The results show that 6.9% of the juvenile probands (15-19 years) had healthy periodontal tissue (CPITN 0), whereas bleeding on probing and calculus (CPITN 1 + 2) were registered in 86.2%. In the 35-44 year age group, 1.7% were periodontally healthy, whereas 84.5% displayed plaque retention or shallow pocketing (CPITN 2 + 3) and 12.5% deep pocketing (CPITN 4). The treatment needs in all age groups are confined primarily to calculus removal and instruction in oral hygiene. The clinical attachment level and the calculus index revealed age-related attachment loss and calculus formation, primarily among male probands. The higher khat consumption among the male population is reflected in its detrimental effect on the periodontal tissue, especially among younger probands. Oral hygiene aids have also an influence on periodontal status, with a toothbrush proving more efficient than the miswak. WHO efforts directed towards prophylactic programs need to be intensified but can be staffed by dental hygienists.

Prevalence and severity of periodontal diseases and dental caries in Bangladesh

This paper reviews the results of studies on periodontal diseases and dental caries in Bangladesh. Almost all subjects aged 12 to 19 years (82-95 per cent) and 35 to 44 years (98-100 per cent) had calculus. The various studies showed a wide range of prevalences (14-65 per cent) of subjects with deep periodontal pockets in the age group of 35 to 44. According to a median estimate of the prevalence of subjects with deep periodontal pockets (26 per cent), it can tentatively be concluded that Bangladesh belongs to the 20 per cent of countries in the world where periodontal conditions of the population are among the worst. To assess the caries experience, median DMFT-values of age cohorts from the various studies were calculated. Twelve year olds had a DMFT of 1.7, 15 to 19 year olds of 1.6, 20 to 34 year olds of 1.0 and 35 to 44 year olds had a DMFT of 1.4. These DMFT-values are considered to be upper limit values since they were almost exclusively obtained from urban and peri-urban populations. The age effects observed indicated that there might have been an upward trend in caries activity in (urban) children before 1980. Cohort effects indicating secular changes in caries experience over the last 15 years have not been observed. It is therefore tentatively concluded that the caries activity in Bangladesh has remained stable in the last 15 years.

Periodontal reasons for tooth loss in an Asian population

This study analysed data on periodontal reasons for tooth extractions, obtained from 52 dentists practising general dentistry in Singapore. The results revealed that, out of 2172 teeth extracted from 1276 patients, 35.8% were lost due to periodontal disease and 35.4% due to caries. Extraction due to periodontal problems increased with age, were more conspicuous in the Indian ethnic group and were frequently associated with pocketing and tooth mobility.

The periodontal health of homosexual men with HIV infection: a controlled study

OBJECTIVE

Identify types, prevalence and severity of periodontal changes associated with HIV infection.

DESIGN

Cross-sectional controlled blinded study.

SETTING

Open access genito-urinary medicine clinic.

PARTICIPANTS

Convenience sample of 794 homosexual men aged 18-65.

OUTCOME MEASURES

Prevalence, extent and severity of probing attachment loss (PAL), pocketing, gingival ulceration, gingivitis, bleeding on probing (BOP), gingival red bands and diffuse and punctate erythema of the attached gingiva (selected a priori).

RESULTS

Prevalences in men with (n = 312) and without HIV (n = 260) were: PAL (> or = 1 site > or = 4mm), 59.6% and 28.5% respectively (P < 0.001, chi 2); pocketing (> or = 1 site > or = 4mm) 51.0% and 31.9% (P < 0.001); BOP, 96.5% and 92.3% (P = 0.038); gingival ulceration, 3.2% and 1.0% (P = 0.031), red banding, 12.2% and 10.0% (P = 0.410); diffuse erythema, 12.5% and 3.1% (P < 0.001) and punctate erythema, 9.6% and 1.1% (P < 0.001). Decreased CD4 lymphocyte counts predicted the presence, extent and severity of PAL (P = 0.023, 0.027 and 0.060) but not pocketing. Oral candidiasis predicted the extent and severity of gingivitis and the presence of diffuse and punctate erythema. (P = 0.037, 0.011, 0.002 and < 0.001).

CONCLUSIONS

Destruction of periodontal attachment is associated with progression of HIV disease whereas pocketing is associated with HIV infection but not disease progression. Gingival ulceration is associated with HIV but gingivitis and erythema of the attached gingiva are most strongly associated with oral candidiasis. Gingival red bands were not associated with HIV infection.

Periodontal status in the United States, 1988-1991: prevalence, extent, and demographic variation

This paper reports estimates of the periodontal status of US population derived from data from Phase 1 of the Third National Health and Nutrition Examination Survey conducted by the National Institute of Dental Research from 1988-1991. A total of 7,447 dentate individuals 13 years of age and older, representing approximately 160.3 million civilian non-institutionalized Americans, received a periodontal assessment. Measurements of gingival bleeding, gingival recession level, periodontal pocket depth, and calculus were made by dental examiners. Assessments were made at the mesiobuccal and mid-buccal sites of all fully erupted permanent teeth present in two randomly selected quadrants, one maxillary and one mandibular. All data were weighted and standard errors calculated by special software to adjust for the effect of sample design. Although over 90% of persons 13 years of age or older had experienced some clinical loss of attachment (LA), only 15% exhibited more severe destruction (LA > or = 5 mm). Prevalence of moderate and severe LA and gingival recession increased with age, while prevalence of pockets > or = 4 mm or > or = 6 mm did not. These data suggest that the increasing prevalence of LA with age is more associated with increasing prevalence of recession than with changes in the prevalence of pockets or age. The extent or number of affected sites with advanced conditions for loss of attachment, pocket depth, or recession was not large for any age group. Differences in prevalence of moderate and severe loss of attachment, moderate and deep pockets, and recession were found among gender and race-ethnicity groups. Females exhibited better periodontal health than males, and non-Hispanic whites exhibited better periodontal health than either non-Hispanic blacks or Mexican-Americans.

Examiner agreement on periodontal indices during dental surveys of elders

Indices used to evaluate periodontal health have been widely accepted in epidemiological studies, yet their reliability cannot be guaranteed. The aim of this study was to evaluate the reliability of periodontal indices applied on elders. 19 elderly subjects, 73-years-old on average, were examined at a 1st appointment by 2 independent examiners. They were re-examined 2 weeks later during a 2nd session. The examinations were performed in a dental chair with good illumination. Periodontal health was evaluated using the community periodontal index of treatment need, and tooth mobility was evaluated using 2 different indices. Inter and intra-examiner agreements were evaluated using kappa statistics. Taken as an overall measurement, the CPITN was a reliable assessment of periodontal treatment need in elders. Disagreement occurred mainly on the evaluation of bleeding and shallow pockets. The detection of fairly mobile teeth was reliable; however, the performance of the more sensitive scale was deceptive. it seems that, in the case of tooth mobility, a choice has to be made between sensitivity or reproducibility. It can be concluded that examiners should be trained carefully since the reliability of the CPITN and tooth mobility evaluation were good but close to a critical level for which an agreement is classified as poor.

Periodontal conditions in older age cohorts aged 65 years and older in Japan, measured by CPITN and loss of attachment

Periodontal conditions were assessed by CPITN and loss of attachment in 601 elderly people randomly selected in Kitakyushu, Japan. The percentage of edentulous persons was 21 per cent, 38 per cent and 65 per cent in the 65-74 year, 75-84 year and 85 years and older groups, respectively. In dentate persons, over 60 per cent had pocket probing depths of 4mm or more; in the majority loss of attachment did not exceed 5mm. The mean numbers of sextants with pocket probing depths of 4-5mm (CPITN 3) and probing depths of 6mm and more (CPITN 4) were similar in each age group. The mean numbers of sextants with both pockets and loss of attachment showed no clear difference among groups. Only the mean number of excluded (no, or only one tooth) sextants increased with increasing age from 1.9 to 3.1. It could therefore be suggested that in the population examined the progress of periodontal destruction with increasing age might not be shown by an increase in pocket probing depth, loss of attachment or gingival recession, but only by an increase in tooth loss. The results for the remaining teeth show that a) severe loss of periodontal attachment (6mm or more) was not frequently encountered, b) recession (attachment loss without pocketing) was present at only very low levels, c) the main periodontal problem seemed to be pocketing, which could be treated. It is therefore tempting to suggest that some of the teeth already lost, could have been saved if proper self- and professional care had been applied.

The periodontal status of Jordanian adolescents measured by CPITN

The prevalence and severity of periodontal disease were assessed in 2039, 15-16 year old Jordanian adolescents using the Community Periodontal Index of Treatment Needs (CPITN). The findings revealed that around 37 per cent of the subjects had a healthy periodontium (score 0), whilst 40 per cent had bleeding on probing (score 1). Calculus deposits (score 2) were found in 17.4 per cent of the subjects. Both shallow and deep pockets (scores 3 and 4) were present in only a small percentage of the sample (5.32 per cent and 0.29 per cent, respectively). When the severity of the periodontal condition was assessed, it was found that bleeding on probing was present in 2.4 sextants per person and calculus deposits in 1.04 sextants per person. The sextants which were affected by shallow and deep pockets were minimal (0.32 and 0.02 sextant per person respectively). The mean number of healthy sextants per person was found to be 2.22. These findings indicate that gingival rather than periodontal disease is more common in Jordanian adolescents.

Changes in periodontal treatment needs. A follow-up study of Oslo citizens from the ages of 35 to 50 years

A random sample of 35-year-old subjects from Oslo took part in a dental survey in 1973 and were re-examined in 1988. Eighty-one subjects (85%) attended the final examination. The need for periodontal treatment was assessed by the Periodontal Treatment Need System (PTNS), and the oral hygiene by the Simplified Oral Hygiene Index (OHI-S). The participants attended a structured interview and answered a questionnaire about general and dental health habits as well as psycho-social factors. Only small changes in the distribution of subjects in the different PTNS categories were found to have taken place during the 15 years. In 1973, 56.8% were in need of scaling (Class B) and 32.1% had one or more deep inflamed pockets (Class C), and in 1988 the scores were 54.3% and 30.1% respectively. A logistic regression model was used to study the associations between risk factors and increased treatment need, as expressed by increase in the number of C-quadrants. Increased number of C-quadrants was positively associated both with short duration of education and with no interdental cleaning. Using a socio-ecological model for periodontal diseases, variables describing the items "behaviour" and "environment" were found to be most closely associated with increased need for periodontal treatment.

Periodontal attachment loss among adults aged 60+ in South Australia

This study aimed to provide oral epidemiological data describing periodontal destruction among older adults in South Australia. A cross-sectional survey design was employed and periodontal assessments were made among 801 persons aged 6+ drawn at random from the non-institutionalized population. Measurements of pocket depth (PD) and gingival recession (GR) were made at three sites on all teeth and used to compute loss of attachment (LOA). An average of 17 teeth per person were measured. LOA of 4+ mm at one or more sites was observed among 89.1% of persons. A mean of 78.1% of sites per person had LOA of 2+ mm (extent) and the mean LOA at sites with LOA of 2+ mm was 3.09 mm (severity). Extent and severity were greater for males and for persons aged 80+ years. Extent was virtually identical for mesio-buccal and disto-lingual sites, while severity was virtually identical for mid-buccal and disto-lingual sites. Patterns of GR and PD varied according to the jaw and type of tooth. Maxillary first and second molars had the greatest mean LOA, and the majority of LOA in the maxilla was due to PD. In the mandible there was less variation in LOA among anterior and posterior teeth, and LOA tended to be more equally divided between GR and PD. Levels of periodontal destruction of South Australia were broadly similar to results from North American studies of older adults which have used full-mouth periodontal assessments.

Association of lifestyle with periodontal health

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

National survey of periodontal status and treatment need among Nigerians

A national pathfinder survey of periodontal conditions and treatment needs was carried out among 4631 male and female Nigerians drawn from all four Primary Health Care (PHC) Administrative zones. The survey was conducted according to WHO Basic Methods. Differences between PHC zones, and rural and urban communities were examined. The Chi-Square test was used to analyse differences in frequencies between groups. The percentage of healthy subjects was very small, nearly zero, in all age groups and in all zones. A majority of subjects had calculus. The prevalence of shallow and deep pockets were relatively high; prevalence of '4 or 5mm pockets' increased from 39 per cent among 15 year olds to 57 per cent among those 25-29 years before declining to 17 per cent among those 65 years of age and older. Prevalence of deep pockets increased steadily with age. Few sextants had '4 or 5mm pockets' or deep pockets. There were also very few edentulous sextants. Differences between the PHC zones, and rural/urban areas were mainly limited to number of sextants with '4 or 5mm pockets'. Virtually all subjects needed one form of periodontal treatment as assessed by the CPITN.

Risk factors for periodontal diseases in Ilala, Tanzania

The purpose of this study was to evaluate associations between periodontal diseases and the common risk factors in Ilala, Tanzania. To determine behavioural and socioeconomic background, a total of 1764 subjects (827 males and 937 females) aged 3-84 years were randomly selected and interviewed. The subjects were examined clinically for the presence of plaque, calculus, gingival inflammation, periodontal probing depths and gingival recessions. Logistic regression analyses showed that the risk factors for gingivitis were male sex, presence of plaque or calculus and use of local "mswaki", the risk factors for periodontal pockets were age of 35 years or more, presence of plaque, and rural residence. The risk factors for gingival recession were identified as age of 35 years or more, male sex, lower educational status, presence of plaque and gingival inflammation. The most significant risk factors to have periodontal diseases in this study population were age, sex, education, rural residence, plaque and calculus.

[Cariologic and periodontal screening of children aged 7, 12 and 14 years in the city of Debrecen. II. Periodontal status and need for treatment]

The aim of present survey was to gain epidemiological data on periodontal condition of 7, 12 and 14 yrs old (40 children in 7, 92 children in 12 and 84 children in 14 yrs old groups) schoolchildren as assessed by the CPITN. The peridontal health of children proved to be very poor. Only 33.3% of 7 yrs old, 20.9% of 12 yrs and 13.1% of 14 yrs old children showed healthy gingiva. Bleeding on probing was observed in 66.7% of 7 yrs old group, in 19.8% of 12 and in 16.7% of 14 yrs old groups. The calculus prevalence was 0.0% of 7 yrs old children, 56.0% in 12 and 44.7% in 14 yrs old groups. Oral hygiene instruction was needed by 66.7% of 7, 79.1% of 12 and 86.9% of 14 yrs old children. Scaling was necessary in 11.1% of 7, 59.3% of 12 and 70.2% of 14 yrs old groups. Complex treatment was needed in none of the groups examined.

Three-year root caries incidence and risk modeling in older adults in North Carolina

OBJECTIVES

The purposes of this study were to describe the incidence of root caries and to identify its risk factors in a representative sample of older adults.

METHODS

Root caries incidence was estimated and multivariate risk assessment models were developed to identify predictors for root caries in a three-year follow-up study of 234 black and 218 white noninstitutionalized adults aged 65 and older residing in North Carolina.

RESULTS

During the observation period, 29 percent of blacks developed root caries, compared to 39 percent of whites (P < .05). The mean net DFS increment per person was 0.55 +/- 0.13 root surfaces for blacks vs 0.80 +/- 0.21 for whites (P > .32). Multivariate logistic regression analysis indicated that blacks wearing a partial denture, having some root fragments, having an average gingival recession > or = 2 mm, and being free of P. intermedia were at greater risk for developing new root caries. The model for whites showed that retired people with their most severe gingival recession > or = 4 mm, an average probing pocket depth > or = 2 mm, and taking antihistamines were more likely to develop new lesions.

CONCLUSIONS

These findings suggest that older blacks had less risk of root caries than whites, and in both groups indicators of poor periodontal status increased the risk of root caries.

Relationship between CPITN and periodontal attachment loss findings in an adult population

This study investigates the relationship between CPITN findings and the prevalence and severity of periodontal attachment loss in a rural Kenyan population comprising 1131 persons aged 15-65 years. All persons were examined for calculus, gingival bleeding, pocket depths and attachment loss levels on 4 sites of each tooth present. Recordings of bleeding, calculus and pocket depths were used to compute CPITN scores based on the 10 index teeth originally proposed, and these CPITN scores were subsequently related to the attachment loss findings derived from the full-mouth assessment. In most cases, persons with a CPITN score < or = 1 did not have attachment loss > or = 4 mm. However, among 40+ year-old persons with CPITN score 2 over 90% had attachment loss > or = 4 mm and over 50% of the 50+ year-olds with CPITN score 3 had attachment loss > or = 6 mm. Less than 20% of the 15-29 year-olds with CPITN score 3 had attachment loss > or = 6 mm, and usually the attachment loss levels ranged between 0 and 3 mm. Beyond the age of 35 years over 10% of the sextants with CPITN score 0 had attachment loss > or = 4 mm. Below the age of 35 years more than one third of all sextants with CPITN score 3 had attachment loss levels < or = 3 mm. Thus, the CPITN findings overestimate both prevalence and severity of periodontal attachment loss among the younger age groups and underestimate these parameters among elderly subject.

Preventive behaviors as correlates of periodontal health status

OBJECTIVES

This investigation examined current practices of brushing, flossing, and periodic dental visits and their association with periodontal health status.

METHODS

Data were collected using face-to-face interviews and 40-minute in-home dental examinations with a probability sample of adults 18 years of age or older, having at least one tooth, and living in housing units in the Detroit tricounty area. Complete examinations were performed on 319 individuals.

RESULTS

On average, subjects reported brushing their teeth about twice a day. About one-third of the population reported flossing at least once a day. Loss of periodontal attachment was related to frequency of brushing while subjects who exhibited acceptable flossing ability had less plaque and calculus, shallower pocket depths, and less attachment loss. Subjects reporting a periodic dental visit at least once a year had less plaque, gingivitis, and calculus than subjects reporting less frequent visits. In regression analyses, brushing thoroughness, flossing ability and frequency, and dental visit frequency were predictors of lower plaque, gingivitis, and calculus scores. In turn, these scores were predictors of shallower pocket depths and less attachment loss.

CONCLUSIONS

Brushing, flossing, and periodic dental visits were correlated with better periodontal health. The behaviors appeared to be indirectly related to pocket depth and attachment loss through their associations with plaque, gingivitis, and calculus levels.

Validity and relevance of the criteria of the CPITN

The validity and relevance of the criteria used in the CPITN index are considered against the background of their use throughout the world in the last 15 years. Overall the CPITN criteria satisfy both measures, although some suggestions are given for further refinements. It is recommended that, in conjunction with the Periodontal Screening and Recording system, a simplification to five code numbers for both findings and treatment needs be considered. Other matters considered should include the discontinuation of the description 'shallow pocket', training in the use of a 20 g probing force and a lowering of the age at which periodontal screenings are commenced for children.

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

The aim of this study was to describe the periodontal conditions in 372 35-44-yr-old and 537 noninstitutionalized 65-74-yr-old Hong Kong Chinese who were examined clinically for loss of attachment, recession, probing depth, calculus, and bleeding after probing. Community Periodontal Index (CPI) data and treatment need indications were compiled from index teeth or their substitutes. The prevalence of loss of attachment varied considerably in both cohorts according to the definition of the threshold (> or = 6, > or = 9, and > or = 12 mm, respectively). The mean numbers of teeth with loss of attachment at the > or = 6-mm threshold and at higher thresholds were small. In both age cohorts, about one-fifth of subjects had probing depths > or = 6-mm, while at the > or = 9-mm threshold only 2-3% were so affected. Although recession was an important component of loss of attachment in the younger cohort, in the older cohort the prevalence and extent of recession were greater than for probing depths at thresholds > or = 4 mm. All subjects had one or more teeth with calculus, bleeding, or both, most teeth being so affected. Eighty-four of the 537 65-74-yr-old subjects were excluded either because of edentulousness or because extractions indicated for the remaining teeth would have rendered the subjects edentulous. The distribution of subjects according to their highest CPI score was remarkably similar for the two cohorts. No subjects in either age group were assessed as "healthy" (CPI code 0) or had "bleeding only" (code 1) as their highest score. While most subjects scored CPI code 2 or 3 as their highest score, only 17% of the younger and 15% of the older cohort scored Community Periodontal Index of Treatment Needs (CPITN) code 4.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal treatment needs in 12 and 15 to 19-year-old school children in the Caribbean Island of Antigua, 1990

A national survey was undertaken in 1990 to investigate the periodontal treatment needs in 12 and 15 to 19-year-olds residing in urban and rural areas of Antigua. Using the CPITN procedure, examination of 246 12 year-old children and 456 adolescents (15-19 years) revealed that the CPITN scores of healthy, gingival bleeding, calculus, 4 or 5 mm and > or = 6 mm periodontal pockets were distributed similarly in urban and rural areas. Calculus was the most commonly recorded score, with a prevalence of 46% in 12-year-olds and 56% in 15-19 year-olds. 4 or 5 mm pockets were found in 14% of adolescents, affecting on average less than one sextant per subject, but deep pockets were uncommon, 26% of 12-year-olds and 14% of adolescents had periodontally healthy mouths. Scaling and oral hygiene instruction were the predominant treatment needs in both age groups, but the requirement for complex periodontal care in adolescents was low -3% only.

Dental radiographic findings in the elderly in Helsinki, Finland

A total of 169 dentate persons, aged 76, 81, and 86 years, living at home in Helsinki, Finland, were examined by means of panoramic radiography supplemented by intraoral radiographs. The older the age group, the fewer teeth remained. Altogether 75% of the subjects had radiographically detectable caries. A high proportion of the carious teeth (62%) was found in a relatively small number (24%) of subjects. The number of carious teeth and their percentage of the total number of teeth were greater in the older age groups. The proportion of endodontically treated teeth was 19% in the 76-year-olds and 26% in the 86-year-olds. Of the subjects 41% had periapical periodontitis, which was commoner in root-filled teeth (18%) than in other teeth (4%). Caries and periapical radiolucent and radiopaque findings were commoner in men. Vertical bone pockets (3 mm or deeper) were found in 51% and furcation lesions in 28% of the subjects. Compared with earlier Finnish studies, the results indicate an improving oral health status among elderly Finns.

Periodontal conditions and treatment needs (CPITN) in a worker population in Araraquara, SP, Brazil

This research was carried out to assess the periodontal conditions and treatment needs in a worker population at Sugar and Alcohol Refineries in Araraquara, SP, Brazil. A sample of 528 workers aged 18-64 years was examined by one examiner, previously trained, using the CPITN. The results showed that calculus was the most frequently observed periodontal condition in the age groups 18-19, 20-24, 25-29 and 30-34. In the age groups 35-44 and 45-64, the periodontal condition most frequently observed was shallow pockets. The analysis of the results showed that treating all conditions in all persons would demand an amount of care that could not be provided by any dental service. Therefore, the priority should be based on population strategy and primary prevention programmes to benefit the periodontal health of the majority of people.

Periodontal disease among New England elders

Much of the existing oral epidemiologic literature is limited by having inadequate numbers of the oldest-old in their sample, having used rudimentary periodontal measures, or not having examined probability samples of community-dwelling elders. The New England Elders Dental Study (NEEDS) is the first study that documents the periodontal disease status of a probability sample of 554 adults aged 70 to 96 living within an entire U.S. Public Health Service region. The NEEDS study revealed substantially higher estimates of periodontal destruction among older adults than previous national studies would suggest. These results are consistent with several papers in the literature that suggest that periodontal disease rates are on the increase in older adults. In the coming decades dentistry should be prepared to meet the increasing need and demand for periodontal services in the growing older population.

Changes in periodontal conditions of adults from Melbourne, Australia

Considerable information exists on the changing pattern of dental caries over the last two decades, however, little longitudinal information exists on changes in the pattern of periodontal diseases. This study measured the prevalence and severity of periodontal conditions in a sample of adults from Melbourne, Australia. Data were recorded by a small team of calibrated examiners for 200 subjects who were examined in 1985, re-examined in 1990, then successfully matched. The prevalence and severity of periodontal conditions decreased in subjects over the five-year study period. Over all sites, bleeding decreased from 51.2 per cent of sites examined in 1985 to 41.9 per cent of sites examined in 1990. The proportion of sites with attachment loss of 6 mm or more, decreased from 6.9 per cent to 3.2 per cent over the five-year period. In 1985, 25.6 per cent of sites had a CPITN score of 0, in 1990, 39.8 per cent of subjects presented with the same score. Notwithstanding the limitations of the measurement parameters used in the study, on average, the adult periodontal health of the sample suggested a trend to improvement over the five-year period.

Association between root caries occurrence and periodontal state

To analyze the occurrence of root caries in relation to the periodontal state, we examined clinically a representative sample (n = 4,777) of Finish adults, aged 30 years and older. Our definition of root caries included primary decay on root surfaces, and a subject's periodontal state was described according to the presence or absence of gingival inflammation or periodontal pockets and subgingival calculus and/or overhangings. Subjects with a healthy periodontium seldom (4%) had any caries on root surfaces, whereas 15% had caries in conjunction with gingival inflammation, and 17% in conjunction with deepened pockets. The deeper the pockets, the greater the frequency of root caries for men, but not for women. Subgingival plaque retention showed a strong association with root caries. As the study population represented Finnish adults, the results can be generalized with reasonable confidence.

The prevalence and distribution of gingival recession in subjects with a high standard of oral hygiene

The aim of this study was to evaluate the prevalence and the development/progression of attachment loss and gingival recession at buccal tooth surfaces in a population sample with a high standard of oral hygiene. An additional aim was to study the relationship between attachment loss and gingival recession. The subject sample examined comprised 225 regular dental care attendants at 12 community dental clinics in Sweden. All subjects were subjected to a baseline examination in 1977-78 and were re-examined after 5 years and 12 years. The clinical examinations involved assessment of plaque, gingivitis, probing depth, probing attachment loss and gingival recession. A full-mouth set of intraoral radiographs was obtained at each examination and used for determination of the height of periodontal bone support. The results of the cross-sectional and longitudinal analyses performed showed that in subjects with a high standard of oral hygiene (i) buccal gingival recession was a frequent finding, (ii) the proportion of subjects with recession increased with age, (iii) the prevalence as well as the incidence of recessions within the dentition showed different patterns depending on age, (iv) sites with recession showed susceptibility for additional apical displacement of the gingival margin and (v) loss of approximal periodontal support was associated with gingival recession at the buccal surface.

The validity of the CPITN scoring and presentation method for measuring periodontal conditions

The CPITN is used widely in estimating periodontal treatment needs and, in many cases also to make generalizations about periodontal disease. It is therefore imperative that the hierarchical scoring method used to allocate CPITN scores is validated, and that the presentation of CPITN data reflect the true distribution of periodontal conditions. Data from one study carried out in Melbourne, Australia and one in Jakarta, Indonesia were used to compare CPITN scores on a mouth, sextant and tooth basis. Clinical periodontal components were compared with CPITN scores to establish the validity of the CPITN hierarchical scoring method. The distributions of CPITN scores varied widely on a mouth, sextant and tooth basis, and CPITN scores frequently differed from those indicated by the periodontal components. It was concluded that CPITN data should be presented not only as the % of subjects with each score, but also as the % of sextants, and, if possible, the % of tooth sites with each CPITN score. It was also concluded that there is an advantage in measuring components (calculus and bleeding) as well as CPITN in order to limit the overestimation of treatment needs, particularly for anterior teeth.

Periodontitis and tooth loss: comparing diabetics with the general population

People with diabetes may be at increased risk for periodontal disease. This study compared the periodontal health of diabetic and employed adults. While tooth loss and gingival attachment was similar for both groups, diabetics had a greater prevalence and extent of periodontal pockets. Diabetics with poor metabolic control and calculus also had more periodontitis.

Validity of CPITN's assumptions of hierarchical occurrence of periodontal conditions in a Kenyan population aged 15-65 years

In order to study the validity of the hierarchical principle of the CPITN we used data originating in a cross-sectional study of periodontal disease in a random sample comprising 1131 Kenyans aged 15-65 yr to determine, for each tooth present in each individual, the absence or presence of gingival bleeding, of dental calculus, of a pocket of 4-5 mm or a pocket of 6+ mm, such that each tooth had a separate recording for bleeding, calculus, pocket 4-5 mm and pocket 6+ mm. According to the hierarchical principle of CPITN a tooth with pockets as the most severe finding is assumed positive also for calculus and bleeding, and a tooth with calculus as the most severe finding is assumed positive also for bleeding. Our analysis showed that calculus as the most severe finding of a tooth overestimates the occurrence of bleeding by up to 18%, depending on age of the individuals and the set of teeth examined. Pockets as the most severe finding in a tooth overestimates the occurrence of bleeding by up to 13%, and overestimates calculus by up to 54%, most pronounced in the younger age groups. The effect of these overestimations on prevalence and severity estimates was the most pronounced for the severity measures, particularly regarding the severity of bleeding, whereas prevalence estimates remained relatively unaffected. Undoubtedly, this result should be seen in the light of a very high prevalence and severity of both bleeding and calculus in this population.

Comparative estimation of periodontal conditions by means of different index systems

The aim of the present study was to compare epidemiological data of periodontal disease obtained from a sample of adults by means of different, commonly employed, partial and full-mouth index systems, in order to explore the amount of discrepancy attributed to the methodology per se. 169 dentate subjects, aged 25-64 years, were subjected to a clinical examination, including circumferential probing assessments of pocket depth (PPD) and attachment level (PAL) at all teeth present. The individual mean % of tooth sites with PPD of > or = 6 mm and the % of subjects exhibiting at least one such deep pocket were calculated based on (i) full-mouth data, (ii) data derived from the buccal and mesial surfaces from 1 randomly selected upper and 1 lower quadrant, (iii) probing assessments at the 6 "Ramfjord teeth", (iv) the full-mouth community periodontal index for treatment needs (CPITN), and (v) the partial CPITN based on 10 index teeth. The PAL data were analyzed by means of 3 versions of the extent and severity index, 1 generated by full-mouth assessments and 2 by partial assessments based on 28 and 10 tooth sites, respectively. In the entire sample, the individual mean % of sites with PPD of > or = 6 mm generated by the different systems ranged between 5.0 and 4.2 sites/subject. By full-mouth CPITN scorings, an average of 1.0 score-4 sextants/subject was recorded, while the partial CPITN generated a corresponding value of 0.8 score-4 sextants/subject.(ABSTRACT TRUNCATED AT 250 WORDS)

Application of the community periodontal index of treatment needs (CPITN) in a group of 45-54-year-old German factory workers

The purpose of the present study was to assess the periodontal status of 45-54-year-old patients and to evaluate their treatment needs. Probing depths, bleeding on probing and retentional elements (calculus and overhanging restorations) were determined according to the community periodontal index of treatment needs (CPITN). Additionally, loss of attachment was measured. Results indicated that none of the subjects had a completely healthy periodontium; only 14.7% presented with single sextants which were healthy or needed only improved oral hygiene. Slightly less than half (46.1%) of the subjects were classified as treatment need (TN) category 2 and the remainder (53.9%) as TN3. Of the subjects classed as TN category 3, 14% had the requisite code 4 in one sextant, 18.2% in 2 sextants, 21.7% in half or more of the sextants and 4.2% in all sextants. With a mean of 5.55 sextants per patient, 0.2 sextants per person were scored as code 0 or 1, 1.33 sextants as code 2, 2.79 sextants as code 3 and 1.24 sextants as code 4. The mean loss of attachment was 3.8 mm. Anterior teeth showed less loss of attachment than posterior teeth and buccal and lingual surfaces showed less loss of attachment than mesial and distal surfaces. The data indicate that although this group of 45-54-year-old subjects had high CPITN scores in total TN categories, the codes for complex Treatment Needs (TN3) were recorded only in localized areas.

Prevalence of periodontal disease in a health maintenance organization and comparisons to the national survey of oral health

The purposes of this study were to: 1) characterize the demographics, oral health behavior, and periodontal status of a health maintenance organization sample; 2) investigate the relationship between the location of posterior proximal measurement sites and prevalence estimates for periodontal disease; and 3) compare the prevalence of persons with pockets > or = 4 mm in the present sample to the 1985 NIDR Survey of Oral Health. The sample consisted of 1,090 adults attending a large health maintenance organization. All proximal sites in one randomly selected posterior dental sextant were examined for probing depth using a constant force probe. Demographic, medical, and behavioral factors were determined by questionnaire. Results indicated that the sample consisted primarily of medically and periodontally-healthy middle-aged adults with good oral hygiene habits. Overall, the mean probing depth was 2.95 mm with 10.1% of sites/subject > or = 4 mm. A larger percent of subjects had probing depths with pockets > or = 4 mm at lingual proximal sites than buccal proximal sites. Prevalence of subjects with pockets > or = 4 mm at mesio-buccal sites in the present study was similar to NIDR Region III data (15.3% vs. 17.4% respectively). However, when data from all posterior sites were included, the overall prevalence rate in the present sample increased to 36.8%. These findings indicate that disease prevalence is dependent on the location of surfaces measured and conservatively indicate that NIDR survey data may have underestimated the prevalence of persons with periodontal pockets > or = 4 mm by at least 20%.

Does gingivitis lead to periodontitis in young adults?

It has been assumed that poor oral hygiene predisposes to gingivitis with progression to periodontitis and tooth loss. However, a high prevalence of gingivitis occurs in some populations in which severe periodontitis is rare. To assess whether gingivitis is a reliable predictor of periodontitis, we compared the periodontal health of tea pickers and university students aged between 18 and 30 in Indonesia. Oral hygiene and gingival health was significantly better in students than in tea pickers. However, the prevalence and the severity of chronic periodontitis were similar in the two groups. Our findings suggest that gingivitis is a poor predictor of periodontitis in subjects younger than 30 years. Attempts to prevent periodontitis in young adults through antigingivitis measures such as plaque control may be unsuccessful.

Cross-sectional studies in periodontal disease: current status and implications for dental practice

This paper reviews the cross-sectional national studies of periodontal disease conducted over the past 30 years. Studies included are the 1960-62 HES study (NCHS), the 1971-74 NHANES I study (NCHS), the 1981 RTI study (HRSA), and the 1985-86 Employed Adults study (NIDR). For each of these surveys, the population studied, the general sampling strategy, the periodontal measures collected, and the periodontal findings are compared in this paper. Compared with the first three studies, the NIDR 1985-86 findings appear markedly lower, implying that there has been a decline in the prevalence of periodontal disease. Two possible inferences from these studies are that: (1) there has been a decline in the prevalence of periodontal disease in recent years or (2) the sampling and measurement methods may be sufficiently different for these lower numbers to result. Each inference is explored, with the authors concluding that the latter is more plausible. The implications for future treatment needs are then estimated, given the marked trends in the size of the aging population. The number of older adults over age 55 who will need periodontal services will increase. The adequacy of the number, type, and distribution of dental care providers to meet these increasing needs is discussed.