Relationship of gingival bleeding, gingival suppuration, and supragingival plaque to attachment loss

This study evaluated the relationship between the presence of gingival bleeding, gingival suppuration, and supragingival plaque at 3 month appointments to the incidence of probing attachment loss during a 2-year period of maintenance therapy. The data included in this report were taken during the second and third year of maintenance from 75 periodontal patients who had previously received active therapy in an ongoing longitudinal study. The diagnostic sensitivity, specificity, and positive and negative predictive values were calculated for different frequencies of positive responses for each clinical parameter in relation to sites demonstrating greater than or equal to 2 mm probing attachment loss. Gingival bleeding and plaque were not prognosticators and gingival suppuration was a weak prognosticator of attachment loss during a 2 year maintenance period.

Changes in periodontal disease indicators in 35-year-old Oslo citizens from 1973 to 1984

Periodontal disease indicators were evaluated according to the periodontal treatment need system (PTNS) in random samples of 35-year-old citizens of Oslo in 1973 and 1984. The study indicated that although periodontal disease was a common finding in both samples, there was a significant reduction in score C (indicating need for complex periodontal treatment) in 1984 compared to 1973. Whereas 37.9% of the subjects showed inflamed pockets deeper than 5 mm (score C) in 1973, only 22.9% scored C in 1984 (non-Caucasians excluded). This reduction was most pronounced in females. The mean number of C-quadrants in subjects needing complex periodontal treatment was also reduced from 2.0 in 1973 to 1.7 in 1984. Further analyses of the 1984 sample showed that the mean number of C-quadrants was significantly lower in subjects with low OHI-S scores and in regular dental visitors, whereas sex, years at school, toothbrushing frequency, interdental cleaning habits, previous periodontal therapy, self-experienced need for treatment, health attitude or smoking habits, did not seem to influence the prevalence of score C.

Periodontal conditions in elderly people of Shanghai, People's Republic of China, in 1986

In a stratified multi-stage random sample, 1600 persons of 60 years and older in Shanghai, People's Republic of China, were investigated for periodontal conditions using the CPITN method. Periodontal conditions seemed to deteriorate steadily but rather slowly with increasing age. In the older age groups, there was a trend for an increased proportion of both subjects and sextants scoring CPITN code 4 (deep pockets). The increase in tooth loss with increasing age was more clearly visible: increasing percentages of edentulousness and decreasing mean numbers of teeth remaining in dentate subjects.

Validity of CPITN's hierarchical scoring method for describing the prevalence of periodontal conditions

CPITN has been a frequently used index in periodontal epidemiology during the last decade. It was originally designed to describe treatment needs in populations. For this purpose, it was decided to record only the worst periodontal condition around each index tooth. Such a recording procedure can be regarded as a hierarchical scoring method. Recently, CPITN has been used and recommended for describing the prevalence of periodontal conditions. For this purpose, the index should give a valid estimate of the true periodontal conditions of the index tooth, and not only a recording of the worst condition. The aim of the present study was to test whether the hierarchical assumption of CPITN concerning treatment needs was valid for describing the prevalence of periodontal conditions in a Scandinavian population. The study population comprised 3330 persons from a rural and an urban area in the county of Trøndelag, Norway. The clinical recording was carried out so that it was possible to analyze the indicators both hierarchically and non-hierarchically. The results showed that nearly all the CPITN indicators scored hierarchically gave a correct estimate of the prevalence of bleeding in the population. CPITN codes 3 and 4 overestimated the prevalence of calculus. The degree of overestimation varied by age and tooth type. Most overestimation of calculus occurred on molar teeth with pockets 3.5-5.5 mm and for individuals 13-14 yr of age. There was almost no overestimation of calculus for those aged 65 yr and above.(ABSTRACT TRUNCATED AT 250 WORDS)

Periodontal treatment needs in a population of Ljubljana, Yugoslavia

1692 citizens of Ljubljana in the age range from 15 to 65 yr participated in a survey to assess their periodontal treatment needs. Eighty-three of the participants (4.9%) were edentulous and excluded from the study. Of the 1609 dentate subjects only 2.4% were free of any signs of periodontal disease. According to the Community Periodontal Index of Treatment Needs, (CPITN), reversible gingivitis was present in 19.9% of the population, calculus and shallow pockets (4-5 mm) in 57.4%, and deep pockets (greater than or equal to 6 mm) in 20.3% of the examined participants. Bleeding on probing was the most common finding in a group of 15-yr-old subjects, calculus was most frequently found in 25- and 35-yr-old groups, and shallow and deep pockets in 45-, 55- and 65-yr-old adults. Complex treatment needs increased with age, reaching 42.9% in the 65-yr-old population. However, deep pocketing was in 60% limited to one sextant of the participants with complex treatment needs.

Prevalence of chronic periodontal disease using probing depth as a diagnostic test

The prevalence of chronic periodontal disease was investigated using the occurrence of diseased pocket sites as the diagnostic criterion. The study group comprised 250 dentally aware subjects aged 21-60 years, with a high number of teeth remaining in all age groups. The % of sites with a probing depth of greater than or equal to 4 mm was 16% for the total sample. Most diseased sites (69%) were in the 4-mm class, with only 4% at depths greater than or equal to 7 mm. 82% on the subjects had 1 or more sites greater than or equal to 4 mm. With probing depth as the sole criterion for diagnosis of chronic periodontal disease, prevalence in a sample is heavily dependent on the critical levels selected for probing depth and cut-off point. With critical levels of 4 mm for probing depth and 1 diseased site for the cutoff point, prevalence was 49% in the 21-30 year age group and 95% in the 51-60 year age group. A shift in cutoff point to 40 diseased sites gave a prevalence of 2% and 41%, respectively, in the 2 age groups. For a critical depth of 7 mm and a cutoff point of 1 diseased site, the prevalence was 2% and 43% for the 2 age groups, respectively. Aspects of importance for the decision-making process on disease are discussed.

Periodontal conditions in adults with rheumatoid arthritis

Periodontal conditions among an adult population of 161 dentate patients with rheumatoid arthritis (RA) were compared with those of an age and sex-matched random sample of non-rheumatic subjects. The number of teeth and prevalence of dental plaque, calculus, gingivitis, and deepened periodontal pockets were recorded. Alveolar bone breakdown and the distribution of subjects according to severity of periodontal disease were also registered. There was a tendency towards better periodontal conditions among RA-patients, severe periodontal breakdown occurring less frequently among RA-patients (12%) than among the controls (16%). The RA-patients had less plaque and calculus than the control group, a finding which could indicate a difference in periodontal care.

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

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

Clinical profiles of individuals with and without root surface caries

As part of a collaborative multidisciplinary investigation of root surface caries (RSC), 273 subjects (median age = 57) were clinically evaluated for coronal caries, debris, calculus, gingivitis, periodontal pocketing, recession, abrasion, as well as RSC. The entire study group was divided into three subgroups: (1) subjects whose exposed root surface were without lesions or restorations (non-diseased individuals, n = 43); (2) subjects whose exposed root surfaces had one or more lesions and may or may not have had restorations (diseased individuals, n = 110); (3) subjects with one or more restorations but no lesions, since it was not known whether these restorations were preceded by RSC or abrasion the disease status of these individuals was unclear (n = 120). A comparison of Subgroup 1 (unequivocally non-diseased) and Subgroup 2 (unequivocally diseased) revealed that subjects without RSC had more teeth, less coronal caries, less recession, less debris, less calculus, less gingivitis, and more abrasion. We infer that the common factor underlying most if not all of the subgroup differences is oral hygiene which must therefore be a major disease determinant.

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

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

Periodontal conditions in insulin-dependent diabetics

The aim of this study was to compare the prevalence and severity of periodontal disease in age- and sex-matched adult long- and short-duration insulin-dependent diabetics and non-diabetics. The study involved 82 subjects with long- and 72 with short-duration diabetes and 77 non-diabetics, all aged 20-70 years. The clinical and radiographic examination comprised recordings of the number of existing teeth, absence or presence of plaque and supra- and subgingival calculus, gingival conditions, probing pocket depth and alveolar bone level. There were no significant differences in the number of existing teeth or presence of plaque and supra- and subgingival calculus between long- and short-duration diabetics and non-diabetics. Diabetics, irrespective of the duration of the disease, had a higher prevalence of sites with gingivitis than non-diabetics. Overall, there were no significant differences between the groups regarding the prevalence of tooth surfaces with probing pocket depths of 4 and 5 mm. However, on comparison between age subgroups, long-duration diabetics younger than 45 years had significantly more 4 and 5 mm pockets than non-diabetics. Long-duration diabetics altogether had significantly more tooth surfaces with probing depth greater than or equal to 6 mm than non-diabetics. The radiographs of alveolar bone height exhibited significantly more extensive alveolar bone loss in long-duration diabetics aged 40-49 years than in short-duration diabetics and non-diabetics. This, together with the increased number of subjects belonging to classification groups with severe periodontal disease experience among long-duration diabetics, indicates more periodontal disease in these diabetics.

Wearing of removable partial dentures in relation to periodontal pockets

Using a representative sample of 5028 dentulous Finnish adults the occurrence of periodontal pockets was studied separately for the maxillae and the mandibles among removable partial denture (RPD) wearers and non-wearers. RPD(s) were worn in 11.2% of the 3444 maxillae with at least four natural teeth remaining, and in 7.7% of the 4706 corresponding mandibles (P less than 0.001). Periodontal pockets were more frequently observed in maxillae than mandibles. Wearing of RPDs highly significantly (P less than 0.0001) increased the odds of having periodontal pockets in general (4 mm or more) as well as the odds of having deeper periodontal pockets (exceeding 6 mm). This phenomenon was observed both in the maxillae and in the mandibles. These results suggest that wearing of RPD is a threat to periodontal tissues and that dentists should take care to frequently recall their patients fitted with RPD(s). During the recall visits more attention should be paid to the periodontal conditions of patients wearing RPD(s).

Prevalence and treatment needs of periodontal disease in employees of supermarkets in Japan

In 1987, a survey was carried out to determine the prevalence and treatment needs of periodontal diseases in 2,684 (997 males and 1,687 females) employees of 57 supermarkets in Japan. The aim of this survey was to obtain fundamental data for planning preventive programs for periodontal diseases in the Japanese population. Most of the subjects showed some signs of periodontal disease. The percentages of persons having pathologic pockets 4 mm or deeper increased with age, and reached about 50% in the 45- to 64-year-olds. The percentage of persons affected was similar between the males and females, but the percentage of persons having pathologic pockets tended to be higher in the males than in the females. These findings indicate that the prevalence of periodontal diseases is extremely high among the Japanese population, and that primary prevention of periodontal disease during school days is required in order to maintain the adults' periodontal health.

Probing depth, attachment loss and gingival recession. Findings from a clinical examination in Ushiku, Japan

The present investigation describes probing pocket depth, probing attachment level and recession data from 319 randomly selected subjects, aged 20-79 years, from Ushiku, Japan. The findings are reported as mean values, frequency distributions and percentile plots of the 3 parameters at buccal, interproximal and lingual surfaces of single rooted (incisors, canines, premolars) and molar teeth. Inter-as well as intra-examiner errors for probing pocket depth and probing attachment levels were assessed and found to be small. The data reported revealed that practically all subjects studied had one or more sites in the dentition affected by destructive periodontal disease and that the severity of disease increased with age. It was further observed that in each age group, molars had suffered more attachment loss than single rooted teeth and that the interproximal surfaces as a rule had lost more periodontal tissue support than corresponding buccal and lingual surfaces. The attachment loss difference observed between different surfaces of a given tooth or a group of teeth, however, was comparatively small. In the age groups between 20-59 years, advanced destructive periodontal disease was found in a small subgroup of the subject sample, while after the age of 60 years, widespread destructive periodontitis was common. An attempt was made to examine the progression of destructive disease with age by comparing the frequency distributions of sites with attachment loss of greater than or equal to 3 mm in subjects of different age groups. The data suggested that in younger subject groups, progression was confined to a subset of individuals, while in older age groups, more subjects and sites became involved. A major feature of destructive periodontal disease in older individuals was the accompaniment of attachment loss with recession at the gingival margin. Deep pockets were relatively infrequently detected, while advanced loss of attachment (with recession) occurred at many sites.

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

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

Periodontal diseases in adult Kenyans

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

Methods of evaluating periodontal disease data in epidemiological research

The purpose of the present investigation was to examine the use of different methods of data analysis to examine the pattern of periodontal tissue destruction in a group of adults. A clinical examination was carried out on 319 subjects, 20-79 years of age, randomly selected from the population of the city of Ushiku, Japan. The following parameters were studied: missing teeth, plaque, gingivitis, probing pocket depth and probing attachment level. All surfaces of all teeth were examined. The data obtained were evaluated in 3 ways: (i) mean values for each of the clinical parameters were computed for each subject and age group, (ii) the frequency of subjects with one or more sites of attachment loss above certain thresholds was assessed, (iii) percentile plots were generated in such a way that for each age group the percent of sites in subjects with varying attachment levels could be determined. The results revealed that the subjects included in the study had poor oral hygiene, high frequency of gingivitis and loss of probing attachment which increased with age. The mean annual attachment loss for all tooth surfaces was calculated to be less than 0.1 mm. Severe periodontal tissue breakdown was not as common as might have been expected. Hence, the majority of the subjects in the 20-59 year age group had very little evidence of destructive periodontal disease. In these age groups, a comparatively small subfraction accounted for most of the disease detected. After the age of 60, periodontal disease appeared to be more widespread among the subjects examined.(ABSTRACT TRUNCATED AT 250 WORDS)

Assessment of periodontal disease and dental caries in a population survey using the CPITN, GPM/T and DMF/T indices

2263 randomly selected subjects, aged 15-19, 20-24, 25-29, 30-34, 35-44, 45-54, 55-64, and greater than 64 yr, were assessed for periodontal status, caries status and treatment needs using the Community Periodontal Index of Treatment Needs (CPITN), the ratio of Gingivitis: Periodontitis: Missing teeth (GPM/T index) and the DMF/T index. The advantages of full mouth examination were compared to partial recordings. The CPITN underestimated deep pocketing especially in older age groups and in younger groups overestimated the need for scaling. Although the mean GPM/T number of periodontally affected teeth is in the range of 9-13 teeth and stable throughout the age groups there were age-dependent high risk groups for developing shallow pocketing (20-24 yr) and deep pocketing (45-54 yr), whereas adolescents were at high caries risk. The increase in the number of missing teeth was dramatic after the age of 54 yr only one decade after the high risk age for deep pathologic pockets.

Periodontal conditions in a randomly selected population in Switzerland

The aim of the present study was to evaluate the periodontal conditions of a randomly selected population in the Canton of Berne, Switzerland. From a total of 350 selected persons, 206 (59%) attended the examinations. The Plaque Index (PlI), Gingival Index (GI) and Retention Index (RI), the width of the keratinized gingiva, pocket probing depth (PD) and loss of probing attachment (LA) were recorded on four surfaces per tooth in the entire dentition of the subjects. The statistical analyses were performed using the Statistical Analysis System (SAS). A total of 4253 teeth were scored. On average the patients had 20.7 teeth. The mean PlI of this population was 1.16, the mean GI was 1.34 and the mean RI was 0.81. All three indices were higher in older age groups. 72% of all measurements for pocket probing depths were less than or equal to 3 mm, 26% were between 4 and 6 mm, and only 2% were more than 6 mm. 76% of all sites had lost less than or equal to 3 mm of probing attachment, 21% of the sites had lost between 4 and 6 mm and only 3% had lost more than 6 mm. There were no statistically significant differences either between females and males or between the rural and the urban populations. These results indicate that only a relatively small percentage of the sample representative for the respective area in Switzerland suffered from advanced periodontitis, while the great majority may be treated by rather conservative approaches to periodontal therapy.

Dental health in Icelandic urban children aged 11 and 12 years

A total of 1370 children were examined for caries, gingivitis, periodontal pocketing, calculus and loss of marginal alveolar bone. The mean DFT and DFS scores were 6.2 and 8.7 for 11-yr-old children and 8.2 and 12.1 for 12-yr-olds. The average number of initial caries lesions was 12.4 among 11-yr-olds and 15.7 among 12-yr-olds. The proximal and smooth surfaces accounted for 37% of the total DFS score in the 11-yr-old children and 43% in the 12-yr-olds. The median DFS score for the 11-yr-old boys and girls was 7, while for the 12-yr-old boys it was 9 and for the girls 11. Only 1.8% of the children were free from caries. The occurrence of gingivitis, expressed by GBI, was 20 in both age groups. 8% of the children showed no advanced gingival inflammation, while less than 1% had bleeding gingivitis at all examined surfaces. Supragingival calculus was found in 10% of the children. Neither periodontal pocketing nor loss of marginal alveolar bone was observed.

Representativeness of the "Ramfjord teeth" for epidemiologic studies of gingivitis and periodontitis

Data from the Veterans Administration Dental Longitudinal Study of 736 men each examined four times were analyzed to determine how representative the six "Ramfjord Teeth" (RT) were of the rest of the dentition for epidemiologic studies of gingivitis and periodontitis. Correlation coefficients were calculated between scores for gingival inflammation generated by the RT and scores for the teeth in the rest of the mouth; the correlation coefficients between the two scores tended to be high. Sensitivity, specificity and predictive values were calculated for periodontal pathology classified on the basis of the pocket depths of the six RT. Reliance on the RT resulted in systematic underestimation of the prevalence and incidence of deep periodontal pockets. The RT are more than adequately representative of the rest of the dentition for epidemiologic studies of gingivitis, but are inadequate surrogates of the rest of the mouth for epidemiologic studies of periodontitis.

Oral health effects of smokeless tobacco use in Navajo Indian adolescents

Recent reports have suggested that the use of smokeless tobacco is increasing in adolescents, and is particularly high in Native Americans, causing concern about possible effects on oral health. In this study, 226 Navajo Indians, aged 14-19, were interviewed regarding their use of smokeless tobacco (ST), cigarettes, and alcohol. Midbuccal and mesiobuccal sites on all fully erupted permanent teeth (excluding third molars) were examined for the presence of gingival bleeding, gingival recession, calculus, and loss of periodontal attachment. The oral mucosa was examined for evidence of leukoplakia. 64.2% (145) of the subjects (75.4% of the boys and 49.0% of the girls) were users of ST. Of these, over 95% used snuff alone or in combination with chewing tobacco. 55.9% used ST one or more days per week. 52.2% consumed alcohol, usually beer or wine, and 54.0% smoked cigarettes. 25.5% (37) of the users and 3.7% (3) of the non-users had leukoplakia. The duration (in years) and frequency of ST use (days per week) were highly significant risk factors associated with leukoplakia. However, the concomitant use of alcohol or cigarettes did not appear to increase the prevalence of these lesions. No consistent relationship was observed between the use of ST and gingival bleeding, calculus, gingival recession, or attachment loss, either when comparing users to non-users or when comparing the segment where the tobacco quid was habitually placed to a within-subject control segment. In view of these results, there is little doubt that smokeless tobacco is significantly related to the etiology of leukoplakia. As some evidence exists that smokeless tobacco use is a significant risk factor associated with oral carcinoma, intervention programs to discourage the use of smokeless tobacco by adolescents should be a public health priority.

The relationship between periodontal conditions and perceptions of periodontal health among Pakistani immigrants in Norway

The purpose of the present study was to assess the periodontal status of Pakistani immigrants in Norway, a Third World population in an industrialized country. The findings were related to treatment needs, socio-demographic variables and cultural beliefs about periodontal health. The mean number of remaining teeth ranged from 27.7 in the 20-24-year-old age group to 25.1 in the group of 35-year-olds and older. Very few of the study population had no plaque or no subgingival calculus. Only 7.5% of the participants exhibited no bleeding at any index teeth. Age and residence in Pakistan were the strongest predictors of subgingival calculus and pocket depth. Those from the rural areas of Pakistan had deeper pockets than those from the cities. The data showed a population with high prevalences of teeth with plaque, subgingival calculus and frequent gingival bleeding, but few sites with deep pockets. A periodontal treatment need index would indicate a substantial amount of treatment time. The present study suggests that also the perceived periodontal conditions, should be taken into account when periodontal services and health education strategies are planned. The concept of periodontal illness is introduced, defined as a person's perceptions and interpretations of periodontal symptoms.

Prevalence of deep periodontal pockets in New Mexico adults aged 27 to 74 years

The purpose of this study was to describe the distribution of advanced periodontal destruction (pocket depth equal to or deeper than six mm) in continuous residents, aged 27 to 74 years, of Lordsburg and Deming, New Mexico. The distance from the free gingival margin to the base of the gingival crevice or pocket was measured on the facial and mesiofacial sides of six index teeth. The presence of supragingival calculus, subgingival calculus, and plaque, as well as gingival bleeding around the index teeth, also were evaluated. Of the 372 examinees, only 46 individuals (12.4 percent) had at least one deep pocket equal to or deeper than six mm on at least one site on the six index teeth. Age was significantly associated with prevalence of deep pockets, although about 80 percent of those aged 47 to 74 years did not have deep pockets. Of those with deep pockets, 89.1 percent had fewer than four tooth sites (out of 12) affected. The only significant risk factor of the presence of deep pockets, other than age, was the number of teeth with plaque accumulations. Age and the number of teeth with plaque explained only 10.5 percent of the variability in the prevalence of deep pocketing, suggesting that risk factors other than those included in this study may be important. The results of this study indicate that destructive periodontal disease occurs at selected sites within the mouth, and that about 87 percent of the adults over age 27, in this population, do not have deep pockets in the six index teeth examined.

Periodontal conditions, remaining teeth and oral hygiene habits in a group of Vietnamese refugees in Norway

Since 1975, about 3500 Vietnamese refugees have come to Norway. The purpose of the present study was to report on remaining teeth and periodontal conditions in a population of 200 adolescent and adult Vietnamese refugees. The mean number of remaining teeth ranged from 27.8 in the youngest age group to 24.6 in the oldest. This number of teeth is slightly lower than reported from Norwegian populations, but similar to other Asian populations. Almost all index teeth showed dental plaque, and subgingival calculus was observed in 9 of 10 teeth after the age of 20. Gingival bleeding was seen on all index sites of 26.5% of the subjects and all subjects above the age of 40 had gingivitis adjacent to one or more index teeth. There was a progression of probeable pocket depths with increasing age. In the oldest age group, 72.7% had pockets between 3.5 mm and 5.5 mm. The data indicated that if optimal conditions should be obtained, substantial resources would be required. In populations with limited resources and with relatively few subjects with severe periodontal breakdown, it is suggested that an identification of subjects "at risk" to be dentally handicapped through loss of teeth, should be a priority.

Relationship between the interproximal distance of roots and the prevalence of intrabony pockets

The interproximal distance between adjacent root surfaces and the presence of intrabony pockets (IBP) facing these surfaces, was measured and recorded during 114 gingival flap procedures in 81 patients. Measurements were carried out in 344 interproximal areas and 117 IBP were detected at these sites. The correlation between the interproximal distance and the presence of IBP was positive and statistically significant (r = 0.81; P less than 0.001). The frequency of IBP increased with increasing interdental distance (slope (s) = 5.723). When interdental distances between 2.1 and 4.5 mm were analyzed, the correlation and slope were high (r = 0.96; P less than 0.01; s = 19.87). No significant correlation (r = 0.36; P greater than 0.4) existed when interproximal distances greater than 4.6 mm were analyzed separately. Intrabony pockets were frequently associated with interproximal distances greater than 2.6 mm (20-57.1%). They were less common (5-20%) when the interproximal distances were less than 2.6 mm. Two IBP in the same interdental areas were present only when these areas were greater than 3.1 mm. Based upon the present data, it seems that the frequency of IBP increased as the distance between adjacent teeth increased. However, when this distance was 4.6 mm or more, no further increase in the percentage frequency of IBP was noted.

The potential for increase in the periodontal diseases of the aged population

The periodontal disease trends in the nation's older adults aged 55 to 74 years are assessed using National Center for Health Statistics data spanning an approximate 12-year period. Both the 1960 to 1962 Health Examination Survey and the 1971 to 1974 Health and Nutrition Examination Survey I surveys used similar multistaged stratified probability samples. Examinations were calibrated and the collection of periodontal disease (PI), oral hygiene (OHI) and tooth loss scores were standardized. Data were collected on 1567 persons in 1960 to 1962 and 4746 persons in 1971 to 1974. The mean PI scores between the two surveys were not statistically different. However, when the periodontal diseases were divided into individuals with or without pockets, there was a significant decline in the per cent without pockets (P less than 0.001) while the per cent with pockets remained unchanged or increased. The significant reduction in OHI scores (P less than 0.02) seems to validate the decrease in gingivitis. The improvement in tooth loss was reflected by both the greater proportion of dentulous adults, and among the dentulous, a retention of more than two teeth per person by 1971 to 1974. A hypothesis is discussed regarding tooth retention and the periodontal diseases with projections for the year 2000.

National trends in the prevalence and severity of the periodontal diseases

In summary, between the 1960 to 1962 national health survey and the 1971 to 1974 national health survey, the mean periodontal index scores remained unchanged. However, the classification of adults into broad disease categories showed that those with no evidence of disease increased significantly. This improvement in the nation's experience with the periodontal diseases was restricted to those with gingivitis, and a concomitant improvement was observed in the nation's oral hygiene status; debris scores decreased substantially, whereas little change was observed in calculus scores. Hypotheses have been raised in this paper about the decline in the prevalence of gingivitis and its possible association with variables such as OHI-S scores, socioeconomic status, dental care utilization, cigarette smoking, fluorides, and antibiotics. Also noted between the two surveys was a slight decrease in the prevalence of periodontal pockets in persons younger than age 35, whereas in persons older than 35, there was either no change or a slight increase. During this same period, both total loss of teeth and number of missing teeth per person decreased for all ages. A hypothesis is proposed that links this slight increase in the more severe signs of periodontal disease in older adults to an increase in the number of teeth at risk to the disease. The modest change in the prevalence and severity of advanced periodontal disease may be an early sign of a trend that will become accentuated as a result of a distinct increase in the nation's older population coupled with the increased retention of the natural dentition. Thus, it would seem that a decline in edentulism and an increase in number of teeth per person may well contribute to circumstances that will lead to greater, not lesser, risk of advanced periodontal disease problems in the later decades of life. Although this hypothesis may or may not hold true for today's younger adults as they age, it seems to be the likely occurrence for the nation's older adults, at least for the next several decades. A third national survey, using the same indexes and more current periodontal disease measures, is needed to help to clarify the trends reported here.

Frequency distribution of individuals aged 20-70 years according to severity of periodontal disease

This study is an analysis of the findings in an epidemiologic investigation covering a random sample of 600 individuals aged 20-70 years resident in the city of Jönköping, Sweden. The frequency distribution of individuals according to severity of periodontal disease was determined. The analysis was based on clinical registration of gingivitis, pocket depths and qualitative and quantitative changes of the alveolar bone in a full mouth intraoral survey. In the age groups 20 and 30 years, 96% and 85% of the individuals, respectively, had healthy periodontal tissues or were grouped as having gingivitis without signs of lowering of the periodontal bone level. In the age groups 40, 50 and 70 years none of the subjects was free from signs of gingivitis/periodontitis but, as for all age groups, strikingly few cases (at most 8%) of severe destructive periodontitis were found. The need for periodontal treatment is discussed as well as the role of specific etiologic agents in the development of destructive periodontal disease.

Longitudinal study of periodontal status in individuals aged 15 years in 1973 and 20 years in 1978 in Jönköping, Sweden

The aim of this investigation was to study the periodontal status at the ages of 15 and 20 years in the same individuals. Gingival and periodontal data from 100 adolescents in 1973 constituted the basic material. Eighty subjects could be reexamined in 1978. The mean number of teeth per subject was 27.1 both in 1973 and in 1978. Three individuals in 1973 and two in 1978 had no bleeding gingival units. There was a decrease between 1973 and 1978 in the number of subjects with a high number of inflamed gingival units. The buccal and lingual surfaces also showed lower prevalence of gingivitis, while the proximal surfaces showed a slight increase in prevalence. The prevalence of surfaces with plaque in 1978 was decreased for buccal and lingual surfaces but slightly increased for proximal surfaces. Sixty-six individuals in 1973 and 71 in 1978 had no pocketing. Altogether 75 tooth surfaces with pocketing were diagnosed in 1973 and 21 in 1978. Most of the pockets were located at the proximal surfaces of the molars. Four individuals with infrabony defects in one to two sites were found in 1973 and five in 1978. No progression of the bony defects found in 1973 seemed to have occurred during the 5-year period. In spite of the frequent proximal areas with gingivitis, very few 20-year-olds showed signs of marginal bone loss, which indicates that gingivitis does not necessarily lead to destructive periodontitis in young people.

Prevalence of juvenile periodontitis in Finland

The prevalence of juvenile periodontitis was studied in Finland, in an ethnic group representing a uniform Caucasoid population. The study population consisted of the 16-year-old subjects in the county of Uusimaa, population approximately 1,000,000. The screening study was based on the well-organized national dental care service which provides free dental care for all, up to the age of 17. Bitewing radiographs taken of all subjects at the age of 16 were used as the basic material for screening for juvenile periodontitis. Altogether 8,096 pairs of bitewing radiographs were available from the 16-year-old subjects born in 1960-61, representing 56% of the total age group. The radiographs were examined by the author and 28 cases were singled out for thorough clinical and radiographic examination. The following criteria were set for juvenile periodontitis: -- The patient must be in good general health -- Radiographically detectable bone loss more than 2 mm must be demonstrated around more than one tooth -- Local irritants must not be commensurate with the bone loss. Eight cases among the 8,096 subjects fulfilled these criteria giving a prevalence of 0.1%. With 95% confidence this gives an estimate between 0.06 and 0.26%.