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

Accuracy and precision of using partial-mouth recordings to study the prevalence, extent and risk associations of untreated periodontitis

To study the accuracy and precision of estimating the prevalence, extent and associated risks of untreated periodontitis using partial-mouth recording protocols (PRPs) Methods: A purposive sample of 431 individuals who had never been treated for periodontal disease was recruited from screening clinics at the King Saud bin Abdul-Aziz University for Health Sciences. Data were collected using questionnaires and clinical examinations. The prevalence, extent and risk associations of periodontitis were evaluated. Three PRPs were compared to full-mouth recordings (FRPs) in terms of the sensitivity, specificity, predictive values, and absolute bias. Results: The prevalence of periodontitis was estimated with the highest accuracy and precision by examinations of the full mouth at the mesiobuccal and distolingual sites (FM)MB-DL, followed by random half-mouth (RHM) recordings. The extent of periodontitis was estimated with high precision using all the PRPs, and the absolute bias ranged from -0.6 to -2.3. The absolute bias indicated by OR for risk associations was small for the three PRPs and ranged from -0.8 to 0.8. Conclusion: (FM)MB-DL and RHM were the PRPs with moderate to high levels of accuracy and precision for estimating the prevalence and risk associations of periodontitis. The extent of periodontitis was estimated with high precision using all three PRPs. The results of this study showed that the magnitude and direction of bias were associated with the severity of periodontitis, the selected PRPs and the magnitude of the risk associations.

Periodontal disease prevalence, extent, and risk associations in untreated individuals

Objectives

to examine the prevalence, extent, and risk associations of untreated periodontitis.

Materials and Methods

A purposive sample of subjects who were never treated for periodontal conditions was clinically examined after collecting information about their sociodemographic characteristics, medical conditions, oral health behaviors, perceived stress, and perceived social support.

Results

A total of 431 subjects were recruited (response rate, 97.0%), and their mean age (SD) was 35.4 (13.3) years. Overall, high plaque levels were observed in all untreated individuals. The prevalence of periodontitis and severe (stage III/IV) periodontitis using the American Academy of Periodontology and European Federation of Periodontology (AAP/EFP) classification were 85.4% and 48.5%, respectively. The prevalence of moderate‐severe and severe periodontitis using the definitions of the Centers for Disease Control and Prevention (CDC) and AAP were 78.4% and 31.1%, respectively. The extent of periodontitis expressed as mean% of clinical attachment loss (CAL) ≥ 3 mm and CAL ≥ 5 mm were 34.9% and 14.4%, respectively, while the mean% of a periodontal probing depth (PPD) ≥4 mm and PPD ≥6 mm were 22.0% and 9.2%, respectively. Risk determinants associated with AAP/EFP periodontitis after the adjustment for other variables were age ≥35 years (odds ratio [OR] = 11.5) and lower income (OR = 2.5). Adjusted risk associations with stage II/IV periodontitis included age ≥35 years (OR = 8.2), males (OR = 2.5), lower income (OR = 2.3), and lower perceived stress (OR = 2.0). Adjusted risk associations with CDC/AAP moderate‐severe periodontitis included age ≥35 years (OR = 12.0), lower income (OR = 2.1), and current cigarette smoking (OR = 4.2). Adjusted risk associations with CDC/AAP severe periodontitis included age ≥35 years (OR = 4.5), males (OR = 1.9), lower education (OR = 2.0), lower income (OR = 1.7), uncontrolled diabetes mellitus (OR = 2.0), and current cigarette smoking (OR = 2.3).

Conclusions

The prevalence and extent of periodontitis were high in untreated subjects. Risk associations with untreated periodontitis included age ≥35 years, males, lower income, lower education, current cigarette smoking, uncontrolled diabetes mellitus, and lower perceived stress.

Oral Health Status and Treatment Needs of Paniya Tribes in Kerala

INTRODUCTION

The tribal communities of Kerala have been largely left out of the gains of the Kerala model of development.

AIM

The study was aimed to obtain baseline data of oral health status and treatment needs of Paniyas, in Kerala, India.

MATERIALS AND METHODS

A descriptive population based survey of adult Paniya belonging to index age groups of 35-44 years and 65-74 years was conducted. The study population comprised of 420 subjects drawn from three talukas by stratified cluster sampling. Modified version of WHO Oral Health Assessment Form (1997) was used to assess the oral health status.

RESULTS

Caries prevalence was 40%. The mean DMFT in the 35-44 years age group was 1.52±1.95 and in 65-74 age group it was 18.47 ± 13.10. Oral mucosal lesions were seen in 4.52% and 76.9% had periodontal disease. Tooth brushing was reported by 55.5% of the subjects. Paan chewing, with tobacco or without tobacco, habit was reported by 89.3%. Bi-variate analyses between the CPI scores and age groups showed high statistical significance. The maximum mean treatment requirement was for extraction (1.37 ± 4.01) and was observed in 65-74 age groups.

CONCLUSION

The lack of basic oral health care access is important for high oral disease burden in these populations. Efforts are to be done for basic oral health care facility to these marginal populations.

A specific hygiene hypothesis

Allergic diseases have reached epidemic proportions in Western populations in the last several decades. The hygiene hypothesis proposed more than twenty years ago has helped us to understand the epidemic and has been verified with numerous studies. However, translational measures deduced from these studies to prevent allergic diseases have not proven effective. Recent studies on immigrants' allergies and any potential association between oral infection and allergic diseases prompt me to propose a specific hygiene hypothesis to explain how oral hygiene practices might have contributed to the uprising of hay fever, the most common allergic disease. The historic oral hygiene level in US is closely associated with the emerging allergic epidemic. Future studies to test the hypothesis are needed and verification of the hypothesis can potentially yield highly effective measures to prevent allergic diseases.

Self-report of gingival problems and periodontitis in indigenous and non-indigenous populations in Chiapas, Mexico

OBJECTIVE

To estimate the prevalence of self-reported gingival and periodontal conditions and their association with smoking, oral hygiene, indigenous origin, diabetes and location (urban or rural) in indigenous and non-indigenous adults in Chiapas, Mexico.

METHODS

A cross-sectional study of 1,749 persons, ≥20 years of age, living in four rural and four urban marginal localities in Comitán (Chiapas, México). The variables investigated were: age; sex; indigenous origin; oral hygiene; halitosis; chewing ability; gingival conditions; periodontitis; smoking; alcoholism; diabetes; and location. Bivariate analysis and a logistic regression model were used to identify the association of periodontitis with the independent variables.

RESULTS

In total, 762 (43.6%) indigenous and 987 (56.4%) non-indigenous persons were interviewed. Their mean age was 41 ± 14 years, 66.7% were women and 43.8% lived in rural locations. Gingival problems were reported by 68.5% and periodontitis by 8.7%. In total, 17.9% had used dental services during the previous year, 28.7% wore a removable partial or a complete dental prosthesis, 63.7% had lost at least one tooth, the prevalence of diabetes was 9.2% and the prevalence of smoking was 12.2%. The logistic regression model showed that age, diabetes and the interaction between rural location and indigenous origin were associated with the presence of periodontitis.

CONCLUSIONS

Indigenous people living in rural areas are more likely to have periodontitis. It is necessary to promote oral health practices in indigenous and marginalised populations with a focus on community-oriented primary care.

Dental caries and the associated factors influencing it in tribal, suburban and urban school children of Tamil Nadu, India: a cross sectional study

Background

The study was planned to assess the prevalence of dental caries among tribal, suburban and urban children of Tiruchengode and Erode of Tamil Nadu state, India. The objective of the study was to assess the association of dental caries with family background, dental service availability, transportation and knowledge on preventive dental measures among these three groups

Design and methods

Cross-sectional study. A total of 1028 school children in the age range of 9-12 years from various government schools located in Palamalai and Kolli Hills (tribal), Tiruchengode (suburban) and Erode (urban), Tamil Nadu, were included in the study. Decayed, filled, and missing teeth (DMFT), decayed and filled teeth (dft) and Significant Caries Index were recorded. A specially prepared questionnaire was used to record all the data regarding oral hygiene practices, socioeconomic background, dental treatment availability, parent’s education level were used for the study. ANOVA t-test and post hoc test were used for comparing quantitative variables between the 3 subgroups.

Results

The tribal school children had 89.3% caries prevalence, where as it was 77% in suburban and 55% in urban school children. The mean DMFT score among tribal, suburban and urban school children were statistically significant different (P=0.001) between the three groups. There was a highly significant difference (P=0.001) in the mean DMFT score based on brushing frequency. There was a statistically significant difference (P=0.018) in the mean DMFT scores in the urban group based on the mothers education status. There were no statistically significant differences in the mean DMFT scores based on the presence or absence of television in their house and the parents’ income.

Conclusions

Oral hygiene practices, dietary habits and access to dental care services played an important role in prevalence of dental caries. It was observed that the socioeconomic status, parents’ educational status and mass media influenced the oral health of these children but without a significant contribution.

Is human immunodeficiency virus (HIV) stage an independent risk factor for altering the periodontal status of HIV-positive patients? A South African study

BACKGROUND

The immunosuppresion in HIV patients makes them highly susceptible to microbial infections. The aim of the study was to establish whether HIV stage (as depicted by CD4+ T lymphocyte counts) could independently be associated with periodontal status (as revealed by the measurement of clinical indices).

METHODS

One hundred and twenty HIV-infected patients attending an infectious diseases clinic in the Western Cape, South Africa were included in the study. The periodontal clinical indices such as plaque index, gingival index, pocket probing depth and clinical attachment levels were measured on the mesial aspect of the six Ramfjord teeth. The CD4 + T cell counts were taken from the patients' medical records and patients' HIV stage determined and grouped according to their CD4+ T cell counts into A (<200 cells /mm3), B (200-500 cells /mm3) and C (>500 cells /mm3).

RESULTS

The mean age of 120 HIV-positive patients was 33.25 years and the mean CD4 + T cell count was 293.43 cells/mm3. The probing depth and clinical attachment loss were found to be significantly associated with the total CD4 + T cell counts but not with HIV stage. Significant correlations were found between age and all clinical indices except for clinical attachment loss. No correlation was found between age and HIV stage of the patients. The use of antiretroviral therapy was significantly associated with probing depth and clinical attachment loss, but not with plaque nor gingival index. Significant associations were observed between smoking and all of the clinical indices except for the gingival index. A significant association was observed between the use of interdental aids and all the clinical indices except for probing depth, while brushing was significantly associated with plaque index only. CD4 + T cell counts were significantly associated with brushing frequency (p = 0.0190) and the use of interdental aids (p = 0.0170).

CONCLUSION

The findings of this study conclude that HIV stage, ART and age are not independent risk factors for changes in the periodontal status of HIV-positive subjects but rather that smoking and oral hygiene habits determine their susceptibility to disease.

Reliability of partial-mouth recording systems to determine periodontal status: a pilot study in an adult Portuguese population

BACKGROUND

The efficacy of various partial-mouth recording (PMR) systems is analyzed in the evaluation of periodontal status, using index teeth and different combinations of quadrants.

METHODS

The study group was formed of 108 adults aged 25 to 65 years old. A full-mouth examination (FME) was performed in all participants to determine the periodontal probing depth (PD) and clinical attachment level (CAL) at six sites per tooth. The results of PMR using the Ramfjord teeth, the Community Periodontal Index of Treatment Needs teeth, and the four quadrants individually and combined in pairs were compared to the results obtained with FME.

RESULTS

Concordance with FME in terms of the prevalence of patients with PD ≥4 mm, CAL ≥2 mm, and CAL ≥4 mm was lowest with examination of single quadrants and highest with combinations that included one superior and one inferior quadrant.

CONCLUSIONS

PMR systems, particularly with combinations of a superior plus an inferior quadrant, could be useful to evaluate periodontal status based on PD and CAL. This tool could be useful for epidemiologic surveys on periodontal status.

Destructive periodontal disease in adult Indians from Northeast Brazil: cross-sectional study of prevalence and risk indicators

AIM

The aim of this cross-sectional study was to evaluate the prevalence of destructive periodontal disease and its risk indicators in adult Kiriri Indians from Northeast Brazil.

MATERIALS AND METHODS

Full-mouth periodontal examinations were performed on a sample of 215 Indians (≥19 years). Bivariate analyses and logistic models were applied to assess associations between periodontitis and its putative risk factors.

RESULTS

Prevalence of clinical attachment loss of ≥3, ≥5 and ≥7 mm was 97.8%, 63.8% and 30.8% respectively. Percentage of teeth per individual showing clinical attachment loss of ≥3, ≥5 and ≥7 mm was 49.8%, 18.4% and 8.0% respectively. After adjustment for covariates, individuals aged ≥35 years (OR = 5.83, 95% CI: 3.09-11.00; p < 0.001), men (OR = 2.18, 95% CI: 1.15-4.11; p = 0.02) and diabetics (OR = 3.92, 95% CI 1.03-14.99; p = 0.05) had a higher risk for destructive periodontitis, classified according to the CDC/AAP case definition.

CONCLUSION

Though periodontitis was highly prevalent in Kiriri Indians, only few teeth showed advanced disease, and periodontitis was associated with higher age, male sex and diabetes. A public health action that includes programs of prevention and treatment targeting high-risk groups is vital to improve the periodontal status of this population.

Left-to-right distribution of periodontal disease

AIM

Symmetry is a property established in many human biological systems and it is reasonable to expect that it may also exist in the mouth. The objective of this study was to examine whether there is a similar left-to-right distribution in periodontal disease.

METHOD

Records of 197 patients from the Periodontics department of The Royal Dental Hospital of Melbourne were analysed. The clinical parameters recorded were pocket probing depth, recession, bleeding on probing, mobility and furcation involvement.

RESULTS

The average age of our sample group was 47.5 years old, with 34.5% men and 65.5% women. The results demonstrated significant left-to-right distribution with all the periodontal indices recorded.

CONCLUSION

The findings support previous studies that show that a similar left-to-right distribution exists in the population studied.

Integrating dental health into a family-oriented health promotion approach in Guatemala

The family is the core institution around which the life of each family member revolves. The health status of one family member depends on that of the others. Consequently, health promotion should be targeted at families and communities. Oral and dental health can be integrated into the general health promotion program within families, utilizing principles akin to the common risk factor approach. This article describes a health promotion structure in Guatemala. The family-oriented health promotion approach that is applied in Guatemala suggests a suitable approach that can be incorporated into general health plans elsewhere.

Comparison of periodontal parameters in individuals with syndromic craniosynostosis

Craniosynostosis syndromes are characterized by premature closure of one or more cranial sutures, associated with other malformations, the most frequent of which are the Crouzon and Apert syndromes. Few studies in the literature have addressed the oral health of these individuals. The purpose of this study was to compare the periodontal status of individuals with Apert, Crouzon, Pfeiffer and Saethre-Chotzen syndromes before toothbrushing and compare the efficiency of plaque removal before and after mechanical toothbrushing. The probing depth, plaque index (according to Löe and O'Leary), clinical attachment level, gingival index (according to Silness and Löe) and amount of keratinized mucosa were evaluated before toothbrushing, and the O'Leary plaque index was assessed before and immediately after toothbrushing, on the same day, in 27 individuals aged 11 to 36 years. There was statistically significant difference in the mean probing depth and clinical attachment level among regions (p=0.00; p=0.01, respectively). The gingival index did not reveal statistically significant differences. With regard to the plaque index, the left region exhibited higher plaque index values than the right and anterior regions. No significant results were found in the analysis of keratinized mucosa. Comparison of the O'Leary plaque index before and after toothbrushing revealed statistically significant difference for all syndromes except for the Pfeiffer syndrome (p<0.05). In conclusion, there was no difference in the periodontal status among individuals with syndromic craniosynostosis. The posterior region was more affected than the anterior region as to the presence of plaque, loss of insertion and probing depth. Individuals with Pfeiffer syndrome exhibited greater toothbrushing efficiency than individuals with the other craniosynostosis syndromes.

Periodontal attachment loss in an untreated isolated population of Brazil

BACKGROUND

The aim of this study was to assess the prevalence, extent, and severity of clinical attachment loss (CAL) and to investigate the association of demographic, socioeconomic, and behavioral risk indicators with CAL in an untreated isolated population in Brazil.

METHODS

All subjects aged > or =12 years were identified by a census. Participants were submitted to a full-mouth clinical examination of six sites per tooth and were interviewed using a structured, written questionnaire.

RESULTS

Among the 214 subjects who were interviewed and examined clinically, CAL > or =5 mm in at least one site was observed in 8% of the 12- to 19-year-olds and in all dentate subjects > or =50 years of age; the age-dependent prevalence of CAL > or =7 mm in at least one site ranged from 5% among 12- to 19-year-olds to 83% among subjects > or =50 years old. Multivariate analysis identified plaque (odds ratio [OR] = 2.8), supragingival calculus (OR = 2.9 to 10.6), age > or =30 years (OR = 11.4), and smoking (OR = 2.4) as risk indicators for CAL > or =5 mm and smoking (OR = 8.2) as a risk indicator for CAL > or =7 mm.

CONCLUSIONS

CAL is highly prevalent in this isolated population. The high occurrence of CAL in young age groups and the confirmation of traditional risk indicators for CAL in this study suggest that other factors, such as host susceptibility, may be needed to explain the high levels of CAL found. Age and behavioral factors were risk indicators associated significantly with the CAL found in this population and may be useful indicators of high-risk subjects for periodontal diseases.

Periodontal disease in Kuna albinism: a comparative study

BACKGROUND

In classic albinism, all parts of the body are normal except for the absence of melanin. It is believed that lack of this pigment in periodontal tissues might influence periodontal disease progression. This study was designed to determine the relationship between periodontal diseases and albinism by comparing the clinical periodontal status of a group of native Panamanian Kuna albinos (from San Blas, Panama) to Kuna non-albinos of the same communities.

METHODS

An experimental group of 30 subjects (Kuna albinos aged > or =12 years) was selected and divided into three subgroups according to age. Likewise, a control group of 30 subjects (Kuna non-albinos) was selected and divided in subgroups.

RESULTS

Assessment of oral hygiene and gingival inflammation in albinos by the Silness and Löe plaque index and Löe and Silness gingival index, respectively, was unremarkable compared to control groups. No statistically significant differences were found for number of teeth present, gingival index, plaque index, clinical attachment loss (CAL), probing depth, or gingival recession. As expected, age was a factor in the severity of the periodontal disease; 58% of individuals aged > or =36 years had at least one site with CAL > or =7 mm.

CONCLUSION

Based on the overwhelming similarity of results found between experimental and control groups, albinism does not represent a clinical risk factor in the pathogenesis or exacerbation of periodontal diseases for these individuals.

Risk factors and prevalence of periodontitis in community-dwelling elders in Mexico

AIM

The objective of this study was to determine whether an association existed between chronic systemic diseases/conditions, risk factors common in old age, and the extent and severity of chronic periodontal disease.

MATERIALS AND METHODS

Sociodemographic and lifestyle characteristics were examined by contrasting rural, urban-marginal, and urban social environments in Central Mexico. Data were analysed with Analysis of Variance, chi2 tests, and multivariable logistic regression.

RESULTS

A total of 473 adults 60 years old and over were interviewed; 315 were also examined and underwent laboratory assays (participation rate, 66%); women, 62%; mean age 73+/-8 years; 23% edentulous. The distribution of periodontitis by sociodemographic variables showed differences across locales (73% low-urban, 57% middle-urban, 29% rural). The regression model indicated that periodontitis was more frequently associated with low-urban locale, higher systolic blood pressure, higher body mass index, and worse calculus readings, with an interaction whereby being obese and having a high calculus index was associated with a high probability of having periodontitis.

CONCLUSIONS

Overall periodontal conditions were fair. While we identified oral, systemic, and social variables that modulated the experience of periodontitis, it would appear that urban, low social class elders appeared to have worse periodontal conditions.

Influence of age, sex, plaque and smoking on periodontal conditions in a population from Bauru, Brazil

Epidemiology is the study of health and disease in populations, and of how these conditions are influenced by heredity, biology, physical environment, social environment, and personal behavior. There are many epidemiological studies in Brazilian population but few about the influence of some risk factors in periodontal conditions. This cross-sectional study was performed to assess the influence of age, sex, plaque and smoking on periodontal disease in a population from Bauru (Brazil). Data concerning periodontal status were collected from 380 patients in the University of São Paulo (USP). Measurements of periodontal pocket depths (PPD), clinical attachment levels (CAL), plaque index (PI) of four sites in all teeth were registered. The influence of age, sex and smoking habits on the periodontal parameters were statistically evaluated using descriptive statistical and ANOVA. The correlation between plaque and periodontal parameters was analyzed by Pearson's correlation coefficient. The results showed an increase in the mean of periodontal destruction (PPD and CAL) and a higher number of sites with severe losses with increasing age. Correlation among percentage of sites with plaque and periodontal parameters (PPD and CAL) were positive but weakly related. The male group showed significantly higher means of CAL than the female. Smokers had significantly higher PPD and CAL means than non-smokers. Aging, smoking habit, male sex, and percentage of sites with plaque were associated with a great increase of periodontal destruction, being important factors in the diagnosis of the periodontal disease in this Brazilian population.

Partial-Mouth Assessment of Periodontal Disease in an Adult Population of the United States

BACKGROUND

It has been previously demonstrated, using periodontal data from an untreated population, that half-mouth assessment of six sites/tooth provides an appropriate alternative to whole-mouth assessment of periodontal disease status. Since periodontal destruction exhibits left-right symmetry, it was hypothesized that this would be equally applicable to a population with access to routine dental care.

METHODS

Adult subjects (N = 92) with a range of disease levels participated in the study. Probing depths (PDs) and recession (REC) were measured directly on six sites/tooth, on all teeth (excluding third molars), and clinical attachment levels (CALs) were derived. Partial-mouth assessments, i.e., assessment of limited sites and/or teeth, were compared with whole-mouth assessment as follows. Intraclass correlation coefficients (ICCs) were calculated for mean PD, CAL, and REC, and for percentage of sites with disease above a specified threshold, to determine the agreement between the whole- and partial-mouth assessment. The sensitivity of partial-mouth assessment of disease prevalence also was determined.

RESULTS

For assessment of six sites per tooth in one upper and one lower quadrant, ICCs were consistently >0.80. Assessment of two sites per tooth or only Ramfjord teeth generally underestimated disease extent and severity, and prevalence, compared to half-mouth assessment.

CONCLUSIONS

These results support the use of a half-mouth examination of six sites/tooth, to conserve time, limit cost, and reduce patient and examiner fatigue, while providing maximal clinical information. Assessment of only two sites per tooth or the Ramfjord teeth was not suitable for evaluation of either disease extent and severity or prevalence.

The effect of shared genetic and environmental factors on periodontal disease parameters in untreated adult siblings in Guatemala

BACKGROUND

Increasing evidence supports the role of genetic factors in susceptibility to infectious diseases, including chronic periodontitis. The role of genetic factors in phenotypic expression can be estimated from the degree of resemblance between relatives, as compared with that of unrelated members of a population. Heritability is an estimate of the proportion of total phenotypic variation of a quantitative trait, which is attributable to genetic factors, and is based on the variance within versus between family members. The aim of this study was to determine whether there is a familial basis for periodontal disease status in an untreated population in Guatemala using heritability estimates as a measure of familial clustering of disease.

METHODS

One-hundred and thirteen adult subjects (including both siblings and spouse pairs), age range 35 to 60 years, participated in this study. Full-mouth periodontal examinations were performed and heritability estimates were calculated for mean plaque score, mean gingival index (GI), probing depth (PD), and clinical attachment level (CAL). Intraclass correlation coefficients (ICCs) were calculated using the same parameters for spouses to determine whether a common family environment in adulthood plays a role in disease expression.

RESULTS

Only in the case of mean plaque score and mean recession score were heritability estimates significantly above zero at alpha = 0.05. For spouse pairs, mean GI score, mean PD, and percentage of sites of PD > or = 5 mm showed a statistically significant ICC.

CONCLUSIONS

These results lead us to reject the hypothesis that there is substantial heritability for periodontal disease expression in this population. This may be due to an underlying lack of genetic variation within this sample or may indicate that, compared with the role of environmental factors, the genetic contribution to periodontal disease phenotypes is relatively minor.

Extending scientific horizons in the developing world - the Central American experience

The juxtaposition of 'oral disease' and 'developing countries' invariably evokes thoughts of how one might assist these nations in attaining 'a healthy mouth for all' according to Western standards. In this discussion, the emphasis is shifted to consider collaborations between the industrial nations and those less developed countries, in the conduct and development of research. This potentially fruitful partnership can produce scientific, educational and cultural rewards for mutual benefit.

The Applicability of Half-Mouth Examination to Periodontal Disease Assessment in Untreated Adult Populations

BACKGROUND

Data from whole-mouth examinations are the gold standard for accurate assessment of periodontal disease. Since periodontal destruction exhibits left-right symmetry, however, it is hypothesized that a half-mouth exam provides an appropriate alternative to whole-mouth assessment, with considerable advantage over a more limited partial-mouth assessment of index teeth.

METHODS

Data from 2 untreated populations were utilized in the analyses. Half-mouth (random diagonal quadrants) and Ramfjord teeth assessment was compared with whole-mouth assessment as follows. Intraclass correlation coefficients (ICCs) were calculated for mean plaque index (PI), gingival index (GI), probing depth (PD), and clinical attachment level (CAL) and for percentage of sites with PD > or = 4, 5, or 6 mm; CAL > or = 3, 4, 5, or 6 mm; and recession > or = 3 mm to determine the agreement between the whole- and partial-mouth assessment. Disease prevalence was also determined for both whole- and partial-mouth assessments.

RESULTS

For mean PI, GI, PD, and CAL, both half-mouth and Ramfjord teeth assessment provided an acceptable alternative to whole-mouth assessment (ICCs > 0.92). For percentage of sites above a specified threshold, ICCs were generally greater than 0.90 in all age cohorts for half-mouth assessment, but consistently lower for Ramfjord teeth assessment. Ramfjord teeth assessment also considerably underestimated disease prevalence compared with half-mouth assessment.

CONCLUSIONS

These results support the use of a half-mouth examination procedure, to conserve time, limit cost, and reduce patient and examiner fatigue while providing maximal clinical information. Ramfjord teeth assessment was not as suitable for evaluation of either disease extent or prevalence.

Comparison of periodontal disease status of adults in two untreated indigenous populations of Guatemala, Central America

OBJECTIVE

To compare the periodontal disease levels of two distinct indigenous populations of Guatemala, Central America, to determine whether differences exist.

MATERIAL AND METHODS

Cross-sectional studies were performed in adults from the communities of San Juan La Laguna, SJLL (n = 125) and Tzununa (n = 54). In both cases, full-mouth pocket probing depths (PPDs) and clinical attachment levels (CALs) were measured by a single examiner, and the same examiner was employed in both studies. Recession at each site was derived from PPD and CAL measures.

RESULTS

Tooth number did not differ significantly between SJLL and Tzununa (28.0 and 27.2, respectively). With respect to periodontal disease status, the percentage of sites with PPD >or= 5, 6 and 7 mm did not differ significantly, although mean PPD was significantly greater in the Tzununa sample (P = 0.01). Mean CAL and percentage of sites with CAL >or= 4, 5, 6 and 7 mm was significantly greater in SJLL than in Tzununa (P < 0.005) and the difference increased with age. Mean recession was also significantly greater in SJLL than Tzununa (P < 0.005), as was the percentage of sites with recession >or= 3 mm (P = 0.02), 4 mm (P = 0.002) and 5 mm (P = 0.008).

CONCLUSION

The disease levels differed between these two indigenous Guatemalan communities. Whether this has a primarily environmental or genetic basis remains to be elucidated. :

Subgingival microbiota of indigenous Indians of Central America

OBJECTIVE

To define the subgingival microbial profiles of adult subjects from a previously identified rural community of indigenous Indians in Guatemala, Central America.

MATERIALS AND METHODS

A full-mouth periodontal examination was performed in 114 adult subjects from 45 families. Plaque samples were collected from both deep and shallow periodontal pockets and checkerboard DNA-DNA hybridization was employed to identify 17 species previously associated with periodontitis or health.

RESULTS

Plaque deposits and gingivitis were universal and widespread, and periodontal pocketing > or =5 mm was highly prevalent (84% of subjects). Streptococcus sanguis, Actinomyces naeslundii genospecies 2 and Fusobacterium nucleatum were significantly more prevalent in shallow sites. At the subject level, Actinomyces naeslundii and Peptostreptococcus micros were significantly more prevalent in periodontally-healthy subjects. Actinobacillus actinomycetemcomitans was not detected in any sample.

CONCLUSION

There was no association between periodontal disease status and presence of suspected periodontal pathogens. These latter results conflict somewhat with those from treated populations. However, in this population where extensive plaque deposits and gingivitis are universal, the presence of putative pathogens may be more reflective of the local environment.