Recurrence of destructive periodontal disease after treatment. A long term study

This study demonstrates the difficulties which arise in statistical analysis derived from data of observations in post-treatment healing and recurrence of periodontal disease. Ten individuals received an initial phase of treatment followed by surgical pocket elimination utilizing replaced flap surgery. Clinical measurements of recession and pocketing were taken pre-operatively and 6 monthly thereafter for a period of four years after treatment. The results have shown that surgical treatment is least benefit in cases of mild pocketing, and of most benefit in cases of severe pocketing. A tendency for reduction in recession levels after two years was observed. Pocketing and attachment levels showed a tendency toward relapse as early as 6 months postoperatively. However, this simple observation masks a complex pattern of tissue remodeling in which some sites remain stable, others improve, while others relapse with time. Improvement may occur concurrently in different sites. Continued improvement in the clinical parameters of pocketing and attachment levels was observable in some sites for up to 2 years after surgery, after which the tendency for recurrent disease became more noticeable. Analyses of changes in attachment levels may be misleading, because they may mask the divergent or convergent trends of recession and pocketing, which may be occurring simultaneously. As bursts of healing as well as bursts of destruction could be observed concurrently over the period of 4 years after treatment, it is suggested that a state of "dynamic equilibrium" is established, in which continued tissue remodeling over a protracted period of time, may give rise to the clinical misconception that little or no changes are occurring in the majority of sites with time.

The oral status of elderly removable partial denture wearers

A random sample of 1019 elderly home dwelling persons participated in this study. There were 809 dentate respondents, 28.6% of whom wore removable partial dentures. They were examined for coronal and root caries, gingival recession, pocket depth and loss of gingival attachment. The removable partial dentures were also evaluated. Abutment teeth were found to be more likely to have caries and periodontal disease than all other teeth. Using a MANOVA statistical procedure, the analysis indicated that the partial denture itself, irrespective of any professionally determined problems with the denture, appears to affect coronal and root caries on the teeth of partial denture wearers. Partial dentures judged to need repair or adjustment were related to periodontal status. The data on adverse effects of partial dentures suggest a need for patient education by the dentist and through public health measures, and good oral self care and regular professional recall for people who wear removable partial dentures.

CPITN assessment of periodontal treatment needs in the population of Zagreb, Croatia

The aim of this study was to assess the prevalence and required treatment of periodontal disease in Zagreb using the CPITN system. A total of 3176 subjects of both sexes, divided into reference age groups, was studied using the methods and standards recommended by the World Health Organization, the Community Periodontal Index of Treatment Needs (CPITN). A very high prevalence of periodontal disease in the population of Zagreb was recorded. Gingivitis was found in the entire population of school children and deep pockets were present even in those aged 20 years, the prevalence progressively rising with age. The need for oral hygiene instruction was recorded in almost all subjects examined, and the highest need for specialist periodontal treatment was registered in more than 56 per cent of the oldest subjects, over the age of 64. The data suggests the need for better organisation of preventive services and a more conscientious approach to treatment.

The effect of supragingival plaque control on the subgingival microbiota in subjects with periodontal disease

The present investigation was performed to study the effect on the subgingival microbiota, of a plaque control program which included meticulous oral hygiene instruction, supragingival scaling and professional monitoring during a 2 year period. 300 subjects were examined for periodontal disease and monitored for 2 years without treatment. After the 2 year examination, 80 subjects were invited to participate in a treatment program intended to improve the standard of their self-performed plaque control. 40 of the invitees had a gingivitis and only minor attachment loss, while 40 subjects had moderate signs of periodontitis. 62 subjects volunteered for this treatment. 23 of the volunteers (Group AB) had several sites with deep pockets (> 4 mm). 39 of the volunteers had gingivitis but shallow pockets only (Group C). Group AB contributed 31 shallow pocket sites (A-sites) and 40 deep pocket sites (B-sites), while Group C contributed 63 shallow sites (C-sites). After the clinical examination, samples of the subgingival microbiota were harvested from the 134 A, B and C sites. The 62 subjects were enrolled in a supervised oral hygiene program. Supragingival scaling was carried out. Oral hygiene instruction was provided and repeated on an individual need basis so that all subjects reached and maintained a supragingival plaque score which was < 20%. 24 months after the year 2 examination, the 62 subjects were examined again using both clinical and microbiological examination procedures. The findings demonstrated that carefully performed supragingival plaque control changed the quantity and the composition of the supragingival microbiota.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk indicators for periodontitis in a military treatment population

The association between the periodontal diagnosis and a variety of subject characteristics was studied in a group of 1,783 patients examined at a large military dental clinic. In order of importance, age greater than 30, smoking, male sex, and Filipino racial background were all found to be statistically significant risk indicators for the presence of moderate or advanced periodontitis. A logistic regression equation serving as a predictive model employing these four variables was presented. The strong association found between smoking and advanced periodontitis is consistent with the hypothesis that smoking has cumulative detrimental effects on periodontal health. While these and other risk indicators are neither causative, diagnostic, nor prognostic, they may be helpful in alerting the clinician to more carefully evaluate other clinical signs or laboratory findings of disease.

Frequency distribution of individuals aged 20-70 years according to severity of periodontal disease experience in 1973 and 1983

The aim of this study was to compare changes in periodontal status of a Swedish population over a 10-year period expressed as frequency distributions of individuals according to severity of periodontal disease experience. The study involved 600 randomly selected individuals evenly distributed into age groups 20, 30, 40, 50, 60 and 70 years, examined in 1973 and another randomly selected group of 597 individuals similarly age distributed and examined in 1983. Based on clinical data and full mouth intraoral radiographs all individuals were classified into 5 groups according to severity of periodontal disease experience. In 1983, 23% of the individuals were classified as having healthy periodontal tissues, group 1, compared to 8% in 1973. The changes were most pronounced in the age groups 20 and 30 years, among whom 58% and 35%, respectively, were registered as having healthy periodontium in 1983. The prevalence of individuals with gingivitis without signs of lowered periodontal bone level, group 2, was 22% in 1983 compared to 41% in 1973. In all, 49% of the dentate population in 1973 and 45% in 1983 showed no marginal alveolar bone loss. Moderate periodontal bone loss, group 3, was found in 41% of the population in 1983 compared to 47% in 1973. Among 30-, 40-, and 50-year-olds, there were more, and among 60- and 70-year-olds, fewer individuals in this group in 1983 compared to 1973. 96% of the dentate population were classified as belonging to groups 1, 2 or 3 in 1973 compared to 86% in 1983.(ABSTRACT TRUNCATED AT 250 WORDS)

Progression of periodontal pockets in the age cohort 35-44 years

In 1985 the Health Department of the Italian Telephone Company decided to launch an oral health programme for all its employees and their relatives, with the collaboration of the WHO Collaborating Centre of the Clinica Odontoiatrica Ospedale S. Paolo, Milan. The programme started with an epidemiological survey of dental and periodontal condition; following data analysis, the company also contracted with private dentists to provide oral care. Four years later, in 1989, several studies were set up to evaluate the programme. The WHO Collaborating Centre Milan was requested to evaluate the periodontal care given to a sample of persons living in the Milan area. Seventy-seven individuals with established periodontal lesions were selected out of a group of 678 aged between 35 and 44 years examined in 1985. The same periodontal and dental indices used in 1985, CPITN (Community Periodontal Index of Treatment Needs) and DMFT (decayed, missing, filled teeth), were re-evaluated in these 77 persons and information about any periodontal care since 1985 was collected and checked against the reimbursement records of the Telephone Company. There was an increase in the percentage of persons with deep pockets (from 55.8 to 72.7 per cent), and of the mean of sextants affected (from 0.9 to 1.9). These individuals had been treated for dental problems, as demonstrated by an increase in the F component and a reduction of the D component of the DMFT, but had undergone virtually no treatment for periodontal problems. This may be considered as a longitudinal study on the natural progression of periodontal pathology in individuals with established periodontal lesions.

Periodontal status of older Floridians attending senior activity centers

Older adults attending senior activity centers in Florida cooperated for a questionnaire and an oral examination. The 671 ambulatory dentate seniors in this report had a mean of 17.0 teeth. The mean attachment loss was 3.5 mm from the cementoenamel junction (CEJ), and the mean pocket depth was 2.1 mm. 24% of the sample had at least 1 site with attachment loss of 7 or more mm; the majority of these persons had only 1 or 2 severely-involved sites. The extent and severity index of attachment loss (2 mm or more threshold) was (88%, 3.7 mm). Use of pocket depths alone would have substantially underestimated prevalence of periodontitis in this older sample. Sites with severe attachment loss were typically not accompanied by severe pockets. Evidence of a history of moderate disease in this cross-sectional study was prevalent (62% of persons had a maximum attachment loss of 4-6 mm), as was evidence of a history of severe disease (24% had at least 1 site with attachment loss of 7 mm or more).

Root caries prevalence in black and white North Carolina adults over age 65

The baseline root caries prevalence of 809 dentate black and white home-dwelling North Carolinians over age 65 was determined along with the collection of a large number of demographic and behavioral, clinical, and microbiological variables in the longitudinal Piedmont over-age-65 Dental Study. In comparison to other studies of older adults, the prevalence of decayed-filled root surfaces (DFRS) was low, fewer than 2.0 DFRS in whites, and significantly fewer than that in blacks (1.3 DFRS). Although tooth loss was a substantial problem, nearly half of the white population and almost two-thirds of the black participants exhibited no evidence of root caries history. Even though DFRS prevalence was much lower in blacks, their treatment need for decayed root surfaces (DRS) was significantly higher than for white participants. Correlates with DRS within both race groups appeared to be those that reflect lack of access to dental services or neglect of oral health--decayed coronal surfaces, higher rates of tooth extraction, high CPITN scores and worst loss of attachment greater than or equal to 7 mm, and more than a year since the last dental visit. Some variables were associated significantly with one racial group, but not the other, while others, particularly root surfaces at risk and age, were not associated significantly with DRS. We concluded that although there was considerable neglect of root caries, particularly among blacks, it was not a serious problem among older North Carolinians.

High fruit consumption and the periodontal status of farm workers

The results of a study on the periodontal health of orchard and vineyard workers on apple, grape, citrus and mixed-variety fruit farms are presented. Workers on grain farms were used as controls. The only significant differences in the diets of the different groups were the very large amounts of fresh fruits eaten by the fruit-farm workers. The CPITN index was used to record the periodontal status. Healthy periodontal sextants (code 0) were significantly less in the citrus group (P less than 0.05) compared to the other groups. However, this group also showed a significantly (p less than 0.05) lower prevalence of deep periodontal pockets than the other groups.

New considerations in the prevalence of periodontal disease

International surveys demonstrate that the prevalence of pocketing of 6 mm or more is between 5% and 20% for much of the world's population. A recently completed national survey of employed adults found the prevalence of gingival bleeding was 44%, the prevalence of pocketing of 4 mm or more was 14%, and the prevalence of attachment loss of 3 mm or more was 44%. Risk indicators for a higher prevalence of periodontal disease include increasing age, poor education, lack of professional dental care, previous periodontal destruction, tobacco use, and diabetes. African-Americans show a higher prevalence of juvenile periodontitis and adult periodontitis than whites. The female-to-male ratio in juvenile periodontitis may be close to 1:1. Another report during the review period suggests that periodontal disease in adults may have a strong genetic component. A doctoral dissertation demonstrated that the sensitivities of methods used in a national survey to detect pocketing and attachment loss range from 0.24 to 0.87 in a high-prevalence population.

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

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

Prevalence of juvenile periodontitis in national youth service trainees

The prevalence of juvenile periodontitis was studied in a group of young adults aged 18 to 26 years from the National Youth Service. The study group consisted of a random sample of 350 trainees, 250 males and 100 females. The subjects were examined for plaque scores, gingivitis and pocket depths. Radiographs were used to show bone loss and confirm diagnosis of juvenile periodontitis. Only one subject was diagnosed as having juvenile periodontitis. This represents a prevalence of 0.28% which falls within the range of published prevalence of 0.1% to 3.4% among young adults.

An analysis of the community periodontal index of treatment needs. Studies on adults in France. V. Presentation of CPITN data in cross-tabulations

A total of 1005 subjects were examined using the CPITN and DFT indices. CPITN data were modified in their presentation in order to be suitable for cross-tabulation. Two different methods were considered. One, described previously by Roland et al. (1984), classified subjects according to the combination of their highest CPITN score and the mean of the highest scores of every nonedentulous sextant. The other consisted of multiplying the above mentioned mean by the individual's highest CPITN score. A critical analysis of the methodology showed that the two number system developed by Roland et al. (1984) was impractical. The new method provides a linear array of values from 0 to 16. Very little overlapping of values was observed, which means that a relatively precise periodontal condition is characterised by each value. With this transformation the CPITN can be used as an index that quantifies periodontal conditions instead of treatment needs.

Periodontal treatment needs among Saudi Arabian adults and their relationship to the use of the Miswak

The main aims of this study were, first, to estimate the need for periodontal care among adult residents of Saudi Arabia using the community periodontal index of treatment need (CPITN) and, second, to quantify the relationship between the frequency of using the 'Miswak' and the need for periodontal care. The Miswak is a stick made from the roots of the Arak tree (Salvadora persica) and is used for oral hygiene purposes by many cultures. A total sample of 480 adults aged 35 to 44 years and 65 years and older from the cities of Mecca and Jeddah was included in the study. The findings indicate that the level of need for periodontal care in the sample chosen is low when compared with the findings of similar studies undertaken in other countries. The frequent use of the 'Miswak' was associated with a lower need for treatment.

Oral hygiene, gingivitis and periodontal status of Libyan school children

There is relatively little information about the dental health of Libyan children, so this study was initiated to assess the level of oral hygiene and the gingival and periodontal status in children living in urban and rural parts of Libya. Two thousands and fifteen children aged 7-16 years were examined during 1987 using World Health Organization criteria. The oral hygiene was found to be good (mean oral hygiene index = 0.12); boys demonstrated significantly worse oral hygiene than girls (P less than 0.001). Overall, gingival inflammation was categorised as mild (mean gingival index = 0.05). Boys had more gingivitis than girls (P less than 0.001). Periodontal pockets of more than 3.5 mm were found in 4.1 per cent of 15-16-year-old children.

Proximal attachment loss in Swedish adolescents

The present study describes periodontal conditions in 22 adolescents with proximal attachment loss greater than or equal to 2 mm (AL) and 22 matched referents without AL, all identified in a cross-sectional study of 570 16- and 18-year-old. The cases were followed for 3 years and the referents for 1 year while they were in the care of an organized dental health system. With the exception of 1 case with Morbus Hodgkin, the case and referent groups had a similar background with respect to general health and participation in the dental health program. Bleeding on probing was found at AL sites in 12 of the cases and at corresponding sites in 4 referents. 2 cases had a history of eruption disorders at the AL sites, 1 case had experienced a defective filling and 1 had a root fissure at the AL sites. At re-examinations after 1 and 3 years, 10 out of 21 earlier identified AL cases did not meet the criterion of 1 or more sites with AL greater than or equal to 2 mm. None of the cases showed progression greater than or equal to 2 mm of the lesions. In 1 case, the number of AL sites increased during the period. 4 of the cases harboured Actinobacillus actinomycetemcomitans (A.a.) at AL sites in year 1 and 3 in year 3. 8 of the cases and 4 referents had antibodies specific for A.a.-leukotoxin. The 2 most severe cases, in terms of number of sites with AL, showed bleeding at 1 or more of the AL sites, harboured A.a. at these sites and had serum titers against A.a.-leukotoxin.

Periodontal condition of pregnant women assessed by CPITN

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

Assessment of periodontal status with CPITN and conventional periodontal indices

This study compared CPITN with plaque index (PlI), gingival index (GI), papilla bleeding index (PBI), and probeable pocket depth (PPD). 52 patients were examined, mean age 43 years. Partial mouth random recording (2 upper and 1 lower or 1 upper and 2 lower sextants) was made by CPITN of 150 sextants, and at 6 sites around each tooth in each sextant for each index using a pressure-sensitive probe, with Newman tip and Williams markings, and a WHO 621 tip, probing pressure 0.25 N. Ranges of each index were compared with corresponding CPITN data. Most (71%) sextants had CPITN scores of 4, indicating periodontitis. None had CPITN scored 0 or 1. A given CPITN code was found to represent extremes of ranges for all other indices evaluated. There was no relation between CPITN and PlI or GI, nor did CPITN reflect the number of sites affected per sextant, but there was a tendency for CPITN to relate with PBI and PPD. It was concluded that CPITN may be used as a general indicator of bleeding and pocket depth, but not of plaque or gingivitis. Other indices are required to reliably assess chronic inflammatory periodontal disease status in a given mouth.

Early onset periodontitis in the United States of America

A National Survey of the Oral Health of U.S. children aged 5 to 17 was conducted by the National Institute of Dental Research during the 1986-87 school year. Eleven thousand and seven adolescents aged 14 to 17 years received a periodontal assessment. Their patterns of loss of periodontal attachment as assessed by probing at mesial sites were used to classify adolescents as cases of early onset periodontitis. Approximately 0.53% of adolescents nation-wide were estimated to have localized juvenile periodontitis (LJP), 0.13% to have generalized juvenile periodontitis (GJP), and 1.61% to have incidental loss of attachment (LA) (greater than or equal to 3 mm on 1 or more teeth). The total number of adolescents affected were not trivial. Close to 70,000 adolescents in the U.S. were estimated to have LJP in 1986-87. More destructive GJP affected an estimated 17,000 adolescents. Another 212,000 adolescents were estimated to have incidental LA. Blacks were at much greater risk for all forms of early onset periodontitis than whites. Males were clearly more likely (4.3 to 1) to have GJP than females when other variables were statistically controlled. Gender associations were more complicated for LJP because gender interacted with race. Black males were 2.9 times as likely to have LJP as black females. In contrast, white females were more likely than white males to have the disease by about the same odds. When interactions among demographic variables exist, caution must be taken in comparing results from different studies.

Occurrence of periodontal pockets and oral soft tissue lesions in relation to sulfuric acid fumes in the working environment

The effect of inorganic acid fumes from the working environment on the occurrence of periodontal pockets and soft oral tissues was investigated in a cross-sectional, blind study. A sample of 186 workers was drawn from 4 factories. Of the 170 participants, 82 were working in departments containing acid fumes, and 88 controls had never worked under such conditions. Of the workers exposed to acid fumes 36.9% and of the controls 30.9% had periodontal pockets. The presence of periodontal pockets increased with age significantly more among the acid-exposed workers than among the controls (p less than 0.0001). Oral mucous membrane lesions were observed among 23.2% of the acid-exposed workers and 21.6% of the controls. The findings suggest that acid fumes in the workplace air do not increase the occurrence of oral mucous lesions but may lead to an increase in the prevalence of periodontal pockets.

CPITN assessments in institutionalised elderly people in Kitakyushu, Japan

A CPITN survey was conducted on 1958 institutionalised elderly people aged 59 years and older at 29 of the 30 public and private institutions in the city of Kitakyushu, Japan. About 60 per cent of the sample was edentulous, and the prevalence of periodontal conditions was high. The percentages of dentate subjects with healthy gingivae, bleeding on probing, calculus, shallow pockets, and deep pockets were 3, 4, 32, 52, and 9 per cent respectively. Half the sextants in the dentate subjects were scored as excluded (less than two teeth), indicating that many teeth were missing. Only very few sextants were healthy. These findings indicate the importance of preventive programmes for periodontal diseases in the younger generations, because (a) dental care for the elderly population becomes more difficult with increasing age and (b) periodontal care, if it is available at all, is provided too late for most people.

[Dental health and dental attendance among 25- and 40-year olds]

Dental and periodontal status and treatment needs were among the parameters assessed and related to the use of oral health services of 25- and 40-year olds in the community of Balsfjord, Northern Norway. The 25-year olds were found to have an average of 27.3 teeth. 13.6 DMFT and no deep periodontal pockets (greater than 5.5 mm). The oldest group had an average of 20.2 teeth. Twenty per cent wore a full denture in one or both jaws, and deep periodontal pockets were found in 6% of remaining sextants in those with only one full denture. The effect of oral health care use and social status were found to be different in the two age-groups. In the 25-year olds, frequent dental health care use was found to have a significant negative effect on both caries experience and periodontal pockets when adjusted for sex and educational background. The findings may indicate a possibility of accumulation of false positive diagnoses with overtreatment as a consequence. This may be the main explanation of this negative effect on the dental status. The level of education appeared to have a significant positive influence on the oral health in the 40-year olds. However, the use of oral health care services showed no significant effect in this group.

The effectiveness of differing dental health education programmes in improving the oral health of adults with mental handicaps attending Birmingham adult training centres

There are few published data available relating to dental health in adults with handicaps, or to the effectiveness of dental health education in this group. The present study involved 382 people attending four different adult training centres in Birmingham, UK. Following baseline examinations all participants were given oral hygiene instruction and a scale and polish. Each of the centres was then randomly allocated to one of the four treatment regimens. No specific treatment was provided for the control group; daily supervised toothbrushing was carried out by the participants in the other three groups, with the addition of a three-monthly scale and polish and reinforcement of oral hygiene instruction in group 3 and one-monthly input in group 4. The participants were re-examined after three months and then at six-monthly intervals until 24 months after the baseline examination. The results showed that those people left to their own devices to carry out toothbrushing at home following instruction were not achieving an acceptable standard. Those who were reminded, encouraged and motivated by the adult training centre staff were obviously capable of better standards of oral care. The input of an experienced dental hygienist on a regular basis improved the periodontal condition considerably. Although there were significant differences between the groups throughout the study, particularly in the presence of calculus, the differences between the one-monthly and three-monthly hygienist input were not clinically very apparent after two years, and therefore a one-monthly input would be difficult to justify on a cost benefit basis.

Periodontal conditions in Europe

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

[The tooth transplant in orthodontic treatment planning]

The analysis of all examined transplant cases combined treated with orthodontics shows a success rate of 76%. It must be underlined that the germ development at the time of the transplantation is of utmost importance. The best possible time proved to be at a root development of 2/3 to 3/4. Exact indication position, a careful atraumatic operation method and a short time of operation are also important factors of a successful transplantation. If all these preconditions are met, this method can be recommended.

Relationship between number of teeth and periodontal pockets

The relationship between number of teeth and the prevalence of periodontal disease is an important factor to consider when planning future needs for periodontal care. This is of particular relevance today, when the level of tooth loss is steadily reducing. The aim of the present study was to examine this relationship. Three dependent variables associated with periodontal disease were included in the analysis: 1. The probability of having pockets 4 mm or more. 2. The mean pocket depth for individuals with pockets 4 mm or more. 3. The number of pockets for individuals with pockets 4 mm or more. Age was included in the analysis as a control variable. The study population comprised 2219 individuals in the county of Trøndelag, Norway. The data were analyzed using logistic regression and multiple regression analysis. The probability of having pockets 4 mm or more increased with increasing number of teeth. The average pocket depth decreased with increasing number of teeth. There was no relationship between number of pockets and number of teeth. The increase in the probability of having pockets with a marginal increase in number of teeth was greatest for those aged 53 years and above. It is concluded that this group of people are likely to have the greatest need for periodontal care.

Risk factors associated with abundant dental caries and periodontal pocketing

An adult population of 1275 subjects aged 25, 35, 50, and 65 yr were examined clinically with respect to their periodontal and caries situation. An interview and questionnaire were used to chart the following variables: dietary and oral hygiene habits, social factors, appreciation of natural teeth, and use and availability of dental services. The associations between the risk factors and the probability of periodontal pocketing (greater than or equal to 4 mm) or abundant dental caries (greater than or equal to 7 lesions) among the dentate population were examined using a logistic regression model. The final model correctly classified periodontal pocketing in 65% of the cases and abundant caries in 76%. In addition to social variables, behavioral factors were found to be significantly associated with periodontal pocketing and abundant untreated dental caries.

[The comparative evaluation of the efficacy of surgical and nonsurgical periodontal therapy in relation to the oral hygiene conditions and the severity of the lesions]

A retrospective longitudinal study was carried out to evaluate the efficacy of surgical and nonsurgical periodontal therapy in reducing pocket depth values. This evaluation was made in relation to the strictness with which patients observed professional and domestic oral hygiene and in relation to pretreatment pocket depth values. Results showed that the two forms of periodontal therapy offer comparable results in terms of pockets reduction of either restricted or considerable depth, whereas the most important element in order to achieve therapeutic success was the observation of an effective professional and domestic plaque control.

Analysis of the Community Periodontal Index of Treatment Needs--study on adults in France. IV. The significance of gingival recession

A total of 1005 persons were examined using the CPITN criteria which were recorded for every tooth. All the teeth were also measured on both their buccal and lingual aspects to assess the amount of gingival recession. The combination of pocket depth and gingival recession was computed using a specially written program: 93.8 per cent of the teeth had 1 mm or less gingival recession; 82.5 per cent of the teeth with gingival recession did not present pockets; 26.6 per cent of all subjects had at least one tooth with gingival recession of 2 mm or more but only 9.9 per cent had at least one tooth with 2 mm or more gingival recession and a periodontal pocket.

Periodontal health of 14-17-year-old US schoolchildren

This paper describes the findings related to periodontal health in 14-17-year-old children who participated in the National Survey of Oral Health in US Schoolchildren, conducted by the National Institute of Dental Research (NIDR) during 1986-87. Gingivitis was observed in approximately 60 percent of children in this age group. The proportion of examined sites per child with gingivitis, however, was less than 6 percent. Gingivitis was most common in molar areas in the maxilla and incisor areas in the mandible. Supragingival calculus was observed in nearly 34 percent of the children, and subgingival calculus in approximately 23 percent. The proportion of teeth per child with calculus was approximately 8 percent for supragingival and 4 percent for subgingival calculus. Both types of calculus showed a predilection for molars in the maxilla and incisors and cuspids in the mandible. The mean periodontal attachment loss was 0.33 mm. The teeth most frequently affected by attachment loss of 2 mm or more were maxillary molars and bicuspids, followed by mandibular molars and cuspids.

Periodontal disease in non-insulin-dependent diabetes mellitus

The relationship between diabetes mellitus and oral health status was determined in Pima Indians from the Gila River Indian Community in Arizona. This tribe of native Americans has the world's highest reported incidence and prevalence of non-insulin-dependent (type 2) diabetes mellitus. The probing attachment level, alveolar bone loss, age, sex, Calculus Index, Plaque Index, Gingival Index, fluorosis, and DMFT as well as the diabetic status was assessed in 1,342 Pima Indians who were at least partially dentate. The prevalence and severity of destructive periodontal disease was determined by measuring probing attachment loss and radiographically apparent interproximal crestal alveolar bone loss, two independent but correlated indicators of periodontal destruction. Only diabetic status, age, and the presence of subgingival calculus were significantly associated with both increased prevalence and greater severity of destructive periodontal disease in this population. Diabetic status was significantly and strongly related to both the prevalence and severity of disease after adjusting for the effects of demographic variables and several indices of oral health including the Plaque Index. Subjects with type 2 diabetes have an increased risk of destructive periodontitis with an odds ratio of 2.81 (95% confidence interval 1.91 to 4.13) when attachment loss is used to measure the disease. The odds ratio for diabetic subjects was 3.43 (95% confidence interval 2.28 to 5.16) where bone loss was used to measure periodontal destruction. These findings demonstrate tht diabetes increases the risk of developing destructive periodontal disease about threefold. Furthermore, diabetes increases the risk of developing periodontal disease in a manner which cannot be explained on the basis of age, sex, and hygiene or other dental measures.(ABSTRACT TRUNCATED AT 250 WORDS)

Five-year incidence of tooth loss in Iowans aged 65 and older

The prevalence of missing teeth has been described for US adults, but little is known about the incidence of tooth loss in any segment of the population. This study investigated the 5-yr incidence of tooth loss in a random sample of Iowans aged 65 yr and older residing in two rural counties. These people had an average of 20 teeth at baseline and approximately 40% lost at least one tooth in the subsequent 5 yr. The incidence of tooth loss was highest for mandibular molars and lowest for mandibular canines. Men were more likely than women to lose teeth. Although we were able to identify a number of statistically significant potential risk factors for tooth loss, the multivariate models that incorporated all these factors were not good predictors of which people were at highest risk for tooth loss.

Effect of crown margins on periodontal conditions in regularly attending patients

Subgingival margins of cast restorations have been associated with increased gingival inflammation and probing depth, but it is not known if such effects would be seen among patients receiving regular professional care. In this study, 831 regularly attending patients in 35 North Carolina dental practices were examined. Plaque, gingival inflammation, calculus, and probing depth were assessed on facial and mesiofacial surfaces of the Ramfjord teeth. Surface-specific analyses showed significantly greater (p less than 0.05) gingival inflammation and deeper probing depths with subgingival cast restoration margins for nearly all surfaces examined. Less frequently, decreases in plaque and calculus were associated with the presence of crowns. Intact surfaces in patients with cast restorations were not significantly different from the same surfaces in patients without cast restorations. Even among patients receiving regular preventive dental care, subgingival margins are associated with unfavorable periodontal reactions.

5-year results of a longitudinal study of early periodontitis in 14- to 19-year-old adolescents

This 5-year longitudinal study monitored 167 subjects at ages 14.3, 16.0 and 19.6 years. The aims were (1) to determine loss of attachment greater than or equal to 1 mm in the study group over the 5-year period; (2) to relate baseline levels of oral deposits and gingivitis to the 5-year increment of loss of attachment; (3) to determine whether subjects who had developed loss of attachment greater than or equal to 1 mm by age 16 years were more susceptible to further development of loss of attachment; (4) to evaluate loss of attachment indices. Loss of attachment, plaque, subgingival calculus, gingival bleeding and gingival colour change were measured. At baseline, 3% of subjects had loss of attachment greater than or equal to 1 mm and less than 1% of sites were involved. By age 19 years, 77% had loss of attachment greater than or equal to 1 mm, and 31% of sites were affected. There was a significant correlation between the presence of subgingival calculus at baseline and the 5-year increment of loss of attachment (Pearson's r = 0.26 p less than 0.001). Subjects who had developed loss of attachment by age 16 years still had significantly more sites affected at the more severe 2 mm level 3 years later than their peers (p less than 0.05). The results suggest that a flexible approach is needed in selecting indices of loss of attachment for epidemiological investigations.

Other dental treatment needs in patients who requested removable partial dentures

The aims of this study were to determine the dental and periodontal status and the associated treatment needs, other than that for prosthetic care, in patients who requested removable partial dentures. Forty-six patients who had never worn removable partial dentures before were examined for plaque index, tooth status, gingival index, loss of periodontal attachment and tooth mobility. Prior to prosthetic treatment, 15% of the teeth needed conservative treatment and 1% needed extractions. From the periodontal point of view, 65% of the teeth needed some form of related therapy, and 2% of the teeth were at risk of extraction due to advanced mobility.

Periodontal conditions in a group of Swedish adolescents. (I). A descriptive epidemiologic study

The aim of the present study was to describe, clinically and radiographically, the periodontal conditions in 16- and 18-year-old adolescents from Northern Sweden. The studied samples comprised 287 16-year-olds and 283 18-year-olds. The clinical examination included recording of presence of plaque, bleeding on probing and calculus, and measurements of attachment level and pocket depth. Alveolar bone level was measured on bite-wing radiographs. A history was taken of the individual's occupation, oral hygiene habits and tobacco use, health, medication and previous orthodontic treatment. The prevalence of attachment loss (AL) was 9.4% in the 16-year-olds and 19.4% in the 18-year-olds. Proximal AL was found in 2.8% and 4.9%, respectively, and proximal bone loss in 1% in both groups. With only a few exceptions (3 individuals out of 82), the individuals with AL had their loss either at buccal/lingual surfaces or at proximal surfaces. Calculus was present in 32.7% of the 16-year-olds and in 44.9% of the 18-year-olds. Pocket greater than 3 mm were found in 4%. No significant differences concerning the periodontal status or presence of plaque and calculus were detected between urban and rural groups or between sexes. Toothbrushing 2 or more times/day was performed by 84.3% of the 16-year-olds and by 83.7% of the 18-year-olds.

Periodontal conditions in a group of Swedish adolescents. (II). Analysis of data

Periodontal conditions in adolescents from the north of Sweden have been described in an earlier study. 2 groups were distinguished, one with proximal and the other with buccal/lingual probing attachment loss (AL). The present study analysed the relationship between AL and various background variables: plaque, bleeding, calculus, pocket depth, toothbrushing, experience of fixed orthodontic appliance, general disease, socio-economic level. No significant differences between the total group with AL and that without AL were seen concerning general disease, socio-economic level, experience of orthodontic treatment, or presence of bleeding, plaque or calculus. When groups with AL on proximal surfaces and on buccal/lingual surfaces were analysed separately, it was found that the group with proximal AL more often had plaque, bleeding, calculus and pocket depths greater than or equal to 4 mm than the group with absence of AL and the group with buccal/lingual AL. In the latter group, toothbrushing was more frequent. The differences seen between the group with proximal AL and that with buccal/lingual AL may indicate different etiologies of loss of tooth support in these ages.

The effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque, gingivitis and pocketing in adolescents: a longitudinal cohort study

Reported toothbrushing frequency and the effect of toothbrushing frequency, toothbrushing hand, sex and social class on the incidence of plaque and periodontal disease in a group of 720 adolescents examined at age 11-12 years and again at 15-16 years is presented. At 11-12 years, the mean toothbrushing frequency was 11.5 times per week. By age 15-16 years, it had risen to 13.3 times per week. Children from social class I were less likely to brush once per day or less and more likely to brush twice daily than those from social class V. At both examinations, consistently low negative correlations were seen between reported toothbrushing frequency and the mean scores for buccal and lingual plaque, buccal, mesial and total bleeding. Few significant differences were seen between left- and right-handed toothbrushers at age 11-12 years. These were almost entirely due to differences between the boys. By age 15-16 years, no significant differences existed between the two groups. At both examinations, the boys had higher plaque, bleeding and pocketing scores than did the girls. At 15-16 years of age, all social classes exhibited lower mean total pocketing scores than at age 11-12 years. At 11-12 years of age, the social class differences were mainly contributed by the girls, while at re-examination plaque and bleeding scores for both sexes showed an overall trend to increase from social class I through to social class V. At 11-12 years of age, the boys showed a trend for pocketing to increase from social class I through to social class V. This was absent at 15-16 years of age. The girls showed no such trend at 11-12, but it had emerged by age 15-16. The results again demonstrate the influence of social class and sex rather than toothbrushing frequency and handedness on oral hygiene and gingival health. However, in view of the high number of statistical tests employed, some caution must be exercised in the interpretation of differences significant at the 5 per cent level.

Prevalence and risk indicators for periodontal attachment loss in a population of older community-dwelling blacks and whites

The extent and severity of periodontal attachment loss are described for a random sample of 690 dentate community-dwelling adults, aged 65 or over, residing in five counties in North Carolina. In addition, risk indicators for serious levels of loss of attachment and pocket depth in this population are presented. Pocket depths and recession were measured on all teeth by trained examines during household visits. Blacks had an average of 78% of their sites with attachment loss and the average level of loss in those sites was approximately 4 mm, as compared to 65% and 3.1 min for whites. Because the extent and severity scores in this population were much higher than in younger groups, a serious condition in this group was defined as having 4+ sites of loss of attachment of 5+ mm with one or more of those sites having a pocket of 4+ mm. Bivariate analyses identified a large number of explanatory variables that were associated with increased likelihood of having the more serious periodontal condition. The logistic regression model for blacks includes the following important explanatory variables and associated odds ratios: use to tobacco (2.9), colony counts of B. gingivalis greater than 2% (2.4) and B. intermedius greater than 2% (1.9), last visit to the dentist greater than 3 years (2.3), and gums bleeding in the last 2 weeks (3.9). The model for whites indicated that tobacco use (6.2), presence of B. gingivalis (2.4) and the combined variable of having not been to the dentist in the last 3 years and having a high BANA score (16.8) were important explanatory variables.(ABSTRACT TRUNCATED AT 250 WORDS)

A new approach to investigating associations in periodontal disease data

This paper presents a method for the analysis of data originating from studies of destructive periodontal disease. The proposed method is an extension of the Mantel-Haenszel technique for the analysis of case-control studies and allows for expression of the site-specificity of destructive periodontal disease while maintaining the individual as the unit of analysis. Using data originating from a cross-sectional study of periodontal breakdown and oral hygiene parameters in a random sample of adult rural Kenyans, the proposed method is illustrated and the results compared with results obtained when two alternative analytical methods are used. The results demonstrate that the choice of analytical strategy may have profound implications for the conclusions to be drawn. Depending on the strategy chosen, one may draw conclusions which are qualitatively different and the present study indicates that the direction of these differences is not predictable.

Association of smoking with periodontal treatment needs

A total of 344 Jerusalem hospital personnel participated in the present survey which examined periodontal needs according to CPITN (a measure of treatment needs) and smoking habits. Females and younger subjects were found to be generally periodontally healthier than their male and older counterparts. The effect of both smoking and the number of cigarettes smoked were shown to have a clearly deleterious effect on periodontal status when assessed using the CPITN. Younger women were found to be most susceptible to this effect.

Periodontal disease in children with Down's syndrome

The occurrence of supra- and subgingival calculus, gingival inflammation, periodontal pockets (greater than or equal to 5 mm) and alveolar bone loss was determined in children (10-19 yr) with Down's syndrome (D-S) and in an aged- and sex-matched control group (n = 39). Of D-S children (n = 71), 39 of the patients (mean age 15.5 yr) cooperated in a clinical and roentgenologic examination. Alveolar bone loss was determined around incisors and first molars on intraoral radiographs when the distance between cementoenamel junction (CEJ) to alveolar crest (AC) exceeded 2.0 mm. Alveolar bone loss was diagnosed in 39% of the D-S children compared to 3% in the control group (P less than 0.001). Of the total number of sites examined on radiographs the distance from CEJ to AC exceeded 2.0 mm in 8% in the D-S group compared to 0.2% in the control group (P less than 0.001). The frequency of sites with alveolar bone loss in D-S children was significantly (P less than 0.001) higher around the mandibular incisors compared to first molars. The study shows that early signs of periodontitis are frequently seen in D-S children as early as 11 yr of age and the lesions are first diagnosed in the mandibular anterior region.

The prevalence of periodontal attachment loss in an Iowa population aged 70 and older

Survey dental examinations were conducted in 262 dentate elderly people aged 70 and older and residing in two rural Iowa counties. Over 60 percent of the elderly in these countries were dentate. Buccal and mesial sites of all teeth were assessed for gingival recession, pocket depth, and attachment loss. Mean loss of periodontal attachment was 2.1 mm, and was slightly greater in older age groups and in men. More gingival recession was found on buccal sites and deeper pocketing was found on mesial sites regardless of age group, sex, or tooth type. However, the clinical magnitude of these differences was small. The prevalence of advanced periodontal breakdown was relatively low, with less than 15 percent of the subjects having at least one site with attachment loss of 7 mm or more. However, moderate periodontal breakdown was highly prevalent in this older population.