Oral Health in Polish Fifteen-year-old Adolescents

PURPOSE

To assess caries prevalence and periodontal condition in adolescents in Poland and investigate the factors related to oral health.

MATERIALS AND METHODS

A national survey was carried out among 615 15-year-olds of both sexes living in urban and rural areas. Subjects were selected via cluster sampling. The mean DMFT and its components, the tooth distribution pattern of caries and percentage of subjects with gingival bleeding and gingival pockets were analysed. The information regarding sociodemographic, oral hygiene and nutritional variables was collected via questionnaire to evaluate their relationships with caries and periodontal parameters. The t-test, bivariate and multivariate logistic analyses were conducted to evaluate the differences and dependent variables of caries prevalence and gingivitis.

RESULTS

Caries prevalence was 94.0%, and DMFT was 5.75 ± 3.74. Higher DMFT, DT and MT values were found in rural areas. 50% of the subjects carried about 75% of the total caries burden. Severe caries (DMFT ≥7) was associated with toothbrushing less than twice a day, not using a fluoridated dentifrice, frequent consumption of snacks and absence of pit-and-fissure sealants. The prevalence of gingival bleeding was 37.4% and shallow pockets 2.8%, which were higher in males and rural areas. Gingival bleeding was associated with toothbrushing less than a twice a day, not using dental floss and consumption of fresh fruits and vegetables less than once a week.

CONCLUSION

The prevalence of oral diseases in Poland is very high. Additional strategies must be implemented to promote oral health early on to improve oral hygiene practices and nutritional habits.

Excessive computer use as an oral health risk behaviour in 18-year-old youths from Poland: A cross-sectional study

Background

Many studies have indicated that the excessive use of computers (more than 3 hr/d) might be associated with an unhealthy life-style.

Aim

The aim of this study was to evaluate the relationship between excessive computer use with the condition of the teeth and periodontium and the oral health behaviour of 18-year-olds.

Design

Cross-sectional studies, using a questionnaire, were carried out on 1,611 18-year-olds from Poland. The questionnaire contained questions about socioeconomic status and information about health-related behaviour. The condition of their teeth and gingivae were clinically assessed.

Results

Excessive (>3 h/d) computer use was reported by 492 (31%) of participants, who had an increased frequency of unfilled cavities (1.97 vs. 2.27, p = .047) and a higher risk of oral hygiene neglect (e.g., using dental floss 41% vs. 34%, p = .009). Excessive computer use was also seen to be associated with poor dietary habits. Individuals who declared excessive computer use also had a higher risk of gingival bleeding (35% vs. 29%, p = .009).

Conclusion

In the group studied, excessive computer use by adolescents constituted a risk factor for neglect of oral hygiene, poor dietary choices, and failure to benefit from oral health care. Therefore, these aspects should be included in the risk assessment of oral disease and incorporated into educational programs that promote a healthy lifestyle.

[Periodontal health status assessed by community periodontal index and related factors in adult population of Beijing urban community]

OBJECTIVE

To investigate the periodontal health conditions by using community periodontal index (CPI) and analyze the effects of related risk factors.

METHODS

By stratified random sampling procedure, a total of 1 183 subjects aged 35-74 were recruited from 13 neighbour community and accepted structured interview and periodontal examination.

RESULTS

The percentage of edentulous jaws was 2.3% (27/1 183). For the remaining 1 156 people, the percentage of subject with a highest CPI scores of 0,1,2,3,4 were 0.3%, 0.2%, 46.3%, 31.9%, 21.3%, respectively. At the sextant and tooth level, the numbers of healthy, bleeding, calculus, shallow pocket, deep pocket and missing pocket were 0.26, 0.25, 3.56, 1.06, 0.39, 0.48, and 3.32, 2.02, 15.43, 2.60, 0.70, 3.93, respectively. By multivariable logistic regression models, many risk indicators such as age, gender, smoking, the knowledge, attitudes and practices (KAP) status, etc. were demonstrated to be related to the distribution of deeper and missing pockets.

CONCLUSION

The adult periodontal conditions of urban community were serious and affected by some demographic and behavior risk factors. More than half (53.2%) of the examined subjects require complex periodontal treatments.

Comparison between two methods for periodontal risk assessment

AIM

Risk assessment is increasingly important in periodontology. The aim of this article was to propose a new objective method (UniFe) in order to simplify the risk assessment procedures. UniFe was compared with a computer-based risk assessment tool (PAT(R)).

METHODS

Risk scores for both UniFe and PAT(R) were calculated for 107 patients, randomly selected among patients seeking care at a specialist periodontal clinic. For UniFe risk calculation, the ''parameter scores'' assigned to smoking status, diabetic status, number of sites with probing depth 5 mm, bleeding on probing score (BoP) and bone loss/age, were added and the sum was referred to a ''risk score'', ranging from 1 (low risk) to 5 (high risk). PAT(R) generated a risk score on a scale from 1 (lowest risk) to 5 (highest risk).

RESULTS

The mean UniFe and PAT(R) risk scores were 4.5+/-0.9 and 4.6+/-0.7, respectively. Cohen k-statistics amounted to 0.7, suggesting a good agreement between methods. Difference in risk score between methods was significantly explained by the parameter scores of BoP and bone loss/age (adjusted R2=0.378).

CONCLUSION

The comparison between UniFe and PAT(R) demonstrated a good level of agreement between methods in a randomly selected population referred to a periodontal clinic.

Periodontal health status in Swedish adolescents: an epidemiological, cross-sectional study

The aim of this epidemiological survey was to analyze the periodontal conditions of 19-year old individuals in two rural county areas, i.e. Fyrbodal and Skaraborg, Västra Götaland, Sweden, with special reference to gender and socioeconomic grouping. A randomized sample of 506 individuals (Fyrbodal 250 and Skaraborg 256 individuals, respectively) was clinically examined with regard to oral hygiene, gingivitis, periodontal pockets and gingival recession. Bitewing radiographs were used for assessment of alveolar bone level (ABL) and dental calculus. A questionnaire-based interview regarding oral hygiene habits was included. A majority of the subjects (76%) claimed to brush their teeth at least twice a day, while interdental hygiene means were used daily by 4%. The subjects showed a mean plaque score of 47% and a gingivitis score of 56%. Forty-six % of the adolescents had a plaque score of > or = 50%, whereas the corresponding figure for gingivitis was 62%. The subjects had on average 5.5 teeth with facial gingival recession. The mean prevalence of sites with probing depth (PPD) of > or = 4 mm was 8, out of which 99% were located at proximal sites. A radiographic bone level of > 2 mm was observed at on average 0.4 teeth per subject. Logistic regression analyses revealed that gender (males) and county area (Fyrbodal) were significant factors for a high plaque and gingivitis score. There was no significant difference in periodontal conditions in relation to socio-economic grouping. In conclusion, the survey revealed higher prevalence of plaque and gingivitis among male than female adolescents, but no differences between socioeconomic groups.

Periodontal conditions in a Swedish city population of adolescents: a cross-sectional study

The aim of this epidemiological survey was to analyze the periodontal conditions of 19-year old individuals in an urban area of Sweden, with special reference to gender and socioeconomic factors. A randomized sample of 272 individuals living in Göteborg, Sweden, was clinically examined with regard to oral hygiene, gingivitis, periodontal pockets, probing attachment loss (PAL) and gingival recession. Bitewing radiographs were used for assessments of alveolar bone level (ABL) and dental calculus. A questionnaire-based interview regarding oral hygiene habits was included. Data were analyzed with regard to differences between gender and socioeconomic grouping. The subjects showed a mean plaque score of 59% and a gingivitis score of 44%. 70% of the adolescents had a plaque score of > or = 50%, whereas corresponding figure for gingivitis was 37%. 27% of the subjects had at least one tooth with gingival recession. The mean prevalence of sites with probing depth of > or = 6 mm was 0.5, and the prevalence of PAL > or = 2 mm was 0.7. A radiographic bone level of > or = 2 mm was observed at on average 0.8 teeth per subject. Females had significantly less plaque and gingivitis than males and significantly higher number of teeth with gingival recession. There were no clinically significant differences in periodontal conditions between socioeconomic groups. In conclusion,the survey revealed higher prevalence of plaque and gingivitis among male than female adolescents but no differences between socioeconomic groups.

Labial-cervical-vertical groove in maxillary permanent incisors--prevalence, severity, and affected soft tissue

OBJECTIVES

To investigate the prevalence and severity of a labial-cervical-vertical groove (LCVG) in maxillary permanent incisors and its effect on the associated gingival tissue.

METHODS

A total of 600 adolescents (293 boys and 307 girls, mean age 13.6+/-1.99 years) were randomly selected and examined for the presence of LCVG. The deformity was classified as mild, moderate, or severe according to predetermined criteria. Gingival coverage at the groove site was defined as normal, partial, and irregular.

RESULTS

LCVG was found in 27 adolescents (4.5%). It was unilateral in 24 (89%) and bilateral in 3 (11%). The ratio of central to lateral incisors was 29:1. No sexual dimorphism or side prevalence were found. Mild LCVG was found in 22 incisors, moderate LCVG in 7 incisors, and severe LCVG in one incisor. Moderate LCVG was 5 to 6 times more susceptible to partial or irregular coverage of the gingival margin than mild LCVG. The gingival sulcus in teeth with LCVG demonstrated a significant (P = .001) increase in depth compared to non-LCVG teeth (1.55+/-0.90 mm vs 1.18+/-0.75 mm).

CONCLUSIONS

An LCVG is a deformity confined predominantly to a single permanent maxillary central incisor. Its prevalence is not connected with gender. Most LCVGs are mild and often difficult to detect. However, the greater the severity, the more gingival irregularity is associated. This and the increase in sulcus depth in LCVG incisors are adverse predispositions for periodontal sequelae, calling for cautious oral hygiene maintenance.

Potential associations between chronic respiratory disease and periodontal disease: analysis of National Health and Nutrition Examination Survey III

BACKGROUND

Associations between poor oral health and chronic lung disease have recently been reported. The present study evaluated these potential associations by analyzing data from the National Health and Nutrition Examination Survey III (NHANES III), which documents the general health and nutritional status of randomly selected United States subjects from 1988 to 1994.

METHODS

This cross-sectional, retrospective study of the NHANES III database included a study population of 13,792 subjects > or = 20 years of age with at least 6 natural teeth. A history of bronchitis and/or emphysema was recorded from the medical questionnaire, and a dichotomized variable combined those with either chronic bronchitis and/or emphysema, together considered as chronic obstructive pulmonary disease (COPD). Subject lung function was estimated by calculating the ratio of forced expiratory volume (FEV) after 1 second (FEV1)/forced vital capacity (FVC). Oral health status was assessed from the DMFS/T index (summary of cumulative caries experience), gingival bleeding, gingival recession, gingival probing depth, and periodontal attachment level. Unweighted analyses were used for initial examination of the data, and a weighted analysis was performed in a final logistic regression model adjusting for age, gender, race and ethnicity, education, income, frequency of dental visits, diabetes mellitus, smoking, and alcohol use.

RESULTS

The mean age of all subjects was 44.4 +/- 17.8 years (mean +/- SD): COPD = 51.2 +/- 17.9 years and subjects without COPD = 43.9 +/- 17.7 years. Subjects with a history of COPD had more periodontal attachment loss than subjects without COPD (1.48 +/- 1.35 mm versus 1.17 +/- 1.09 mm, P = 0.0001). Subjects with mean attachment loss (MAL) > or = 3.0 mm had a higher risk of COPD than those having MAL < 3.0 mm (odds ratio, 1.45; 95% CI, 1.02 to 2.05). A trend was noted in that lung function appeared to diminish with increasing periodontal attachment loss.

CONCLUSIONS

The findings of the present analysis support recently published reports that suggest an association between periodontal disease and COPD.

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

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

The periodontal status of Jordanian adolescents measured by CPITN

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

Smoking and periodontal disease severity

This study was performed to assess the influence of smoking on periodontal disease severity. Data concerning periodontal status and smoking habits were collected from 889 periodontal patients: 340 male and 549 female, 21 to 76 years of age, 47.4% being non smokers and 52.6% smokers. Periodontal parameters, recorded by the same examiner (PMC), were: gingival recession (GR), Pocket depth (PD), Probing attachment level (PAL), and mobility (M). The influence of age, sex and tobacco consumption on these periodontal parameters was statistically evaluated using an analysis of variance (ANOVA) with covariates. A non-linear effect model was also fitted by taking the natural logarithms of the response variables (GR, PD, PAL) closer to biomedical phenomena. Mobility was analyzed by a chi2-test. The effect of smoking on periodontitis showed no association with age or with sex. Smoking, age and sex were shown to be statistically significant for periodontitis, by performing both univariate (t-test for equal means) and multivariate tests. p-values for smoking and periodontitis were: GR (p=0.000), PD (p=0.000), PAL (p=0.000) and M (P=0.015). Smoking one cigarette per day, up to 10, and up to 20, increased PAL by 0.5%, 5% and 10%, respectively. The impact of tobacco is comparable to the impact resulting from the factor of age in this sample, increasing PAL by 0.7% for each year of life. Comparison between smokers of less than 10 cigarettes per day (PAL mean 3.72 mm +/-0.86) and non-smokers (PAL mean 3.84 +/- 0.89) showed no differences in PAL (p=0.216), while comparison for smokers from 11 to 20 cigarettes (PAL mean 4.36 +/- 1.23) and for more than 20 cigarettes (PAL mean 4.50 +/- 1.04) demonstrated significant differences (p=0.000). These findings suggest that: (1) tobacco increases periodontal disease severity; (2) this effect is clinically evident above consumption of a certain quantity of tobacco.

Changes in periodontal status of children and young adolescents: a one year longitudinal study

The purpose of the present study was to describe longitudinal changes in accumulation of dental plaque and gingival inflammation, and their effect on changes in sulcus depth of children and young adolescents. Forty one boys and 37 girls aged 1-12 years living in a rural community in Israel were included in the study. At baseline and 12 months later, Loe's Plaque Index (PlI) and Gingival Index (GI), and sulcus depth were examined. Boys' mean age was significantly lower than girls' mean age (6.04 + 2.76 years, and 7.68 + 2.84 years respectively). PlI, GI and sulcus depth were higher in the 12-month examination compared to baseline. PlI was slightly higher in boys, while GI was slightly higher in girls. These differences however, were not statistically significant. At baseline, sulcus depth was significantly greater in girls than in boys, while at 12 months the difference was not significant. The children were grouped by age as follows: 1-5 years, 6-9 years and 10-12 years. PlI and GI mean scores were significantly higher among the 6-9-year-old individuals. Mean sulcus depth for the 10-12-year-old children was greater than that of the 6-9-year-olds at baseline and after 12 months. The effect of age, PlI and GI on the outcome variable (sulcus depth) was examined using a correlation matrix. At baseline, age showed the highest correlation (r = 0.659) followed by GI (r = 0.364) and PlI (r = 0.123). The same pattern was also observed at the 12 months examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Guided tissue regeneration in the treatment of human facial recession. A 12-case report

A guided tissue regeneration procedure was used to treat human buccal recessions, 3 to 7 mm deep, in 12 patients. No procedure for increasing the width of keratinized tissue was performed prior to treatment. A thick bipedicled flap was raised with a semilunar incision in the alveolar mucosa and a marginal incision was extended to the adjacent papilla. The root surface was made concave by curets and burs to create space for regeneration. The membrane was fixed to the cemento-enamel junction and covered by the flap which consisted of the residual gingiva and of alveolar mucosa. The membranes were removed 4 weeks after placement. The patients were recalled 6 months after the reentry procedure. The average reduction in recession was 2.50 mm (P less than 0.01) and the average attachment gain was 2.84 (P less than 0.01). Pocket depth was slightly reduced (0.33 mm), although the degree of reduction was not of statistical significance. The width of keratinized tissue increased slightly (0.83 mm). These results demonstrate the possibility of treating human buccal recessions by means of a guided tissue regeneration procedure, with predictable recession reduction and attachment gain. A minimal amount of keratinized tissue was needed.

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.

Cigarette smoking in a periodontal practice

This case-control study compares the prevalence of cigarette smoking among patients in a periodontal practice (cases) with that of patients in referring general dental practices (controls). Smoking histories of patients (age greater than or equal to 25 years) in a periodontal practice and five general dental practices were obtained by questionnaire. From the general practices, only patients reporting negative histories for periodontitis were studied. Periodontal status of the periodontal practice patients was based on bone loss from full mouth radiographic surveys and gingival pocket depths. Patients were stratified by age (25 to 40, 41 to 55, and greater than 55 years) and sex. The combined frequency of current or former cigarette smoking reported by 196 periodontal practice patients with moderate or advanced periodontitis (M-A perio group) was higher than that reported by 209 general dental practice patients (gen prac group) in all age and sex categories. The age and sex adjusted summary odds ratio for a positive smoking history among M-A perio subjects relative to gen prac subjects was 2.6 (P less than 0.001). Separate corresponding odds ratios (age and sex adjusted) for current smoking versus never smoking in the two groups were 3.3 (P less than 0.001) and for former smoking versus never smoking 2.1 (P less than 0.004). Among current smokers, patients in the M-A perio group reported heavy smoking (greater than 10 cigarettes/day) relatively more often than control subjects (adjusted R.O. = 5.7; P less than 0.001). In the M-A perio group the frequency of current smoking increased with disease severity.(ABSTRACT TRUNCATED AT 250 WORDS)

Application of matched pair procedures to site-specific data in periodontal research

Application of standard statistical procedures to site-specific data in periodontal research is invalid unless site-to-site dependencies are accounted for. In this paper, we present the adjustments required for valid application of matched pair procedures, including the paired t-test and McNemar's chi 2 test for correlated proportions. Examples are given involving data arising from: (1) the comparison of pre- and post-treatment clinical measurements; (ii) split-mouth protocols.

On the prevention of caries and periodontal disease. Results of a 15-year longitudinal study in adults

In 1971-72, a total of 375 adult subjects were recruited for a clinical trial aimed at assessing the effect of a preventive program, based on plaque control and topical application of fluoride, on the incidence of caries and periodontal disease. After a baseline examination, the volunteers were subjected to scaling, root planning and conventional caries therapy. During the course of the subsequent 6 years, they were recalled for preventive measures once every 2-3 months. After the 6-year follow-up examination, however, it was decided to extend the interval between the preventive sessions. Thus, during the next 9-year period, about 95% of the participants returned for preventive measures only 1 to 2 times per year. A small subgroup of about 15 subjects, who, during the initial 6 years had developed new caries lesions or had exhibited additional periodontal attachment loss, however, were also during the following 9 years recalled 3-6 times per year for oral hygiene control and preventive therapy. The re-examination performed in 1987 disclosed that the 317 subjects, who participated during the entire 15-year period, had a low incidence of caries and almost no further loss of periodontal tissue support. It was suggested that improved self performed oral hygiene, daily use of fluoridated dentifrice and regularly repeated professional tooth cleaning effectively prevented recurrence of dental disease.

Prevalence of plaque, gingivitis and caries in 11-12-year-old children in South Wales

The overall eruption and dental disease status of a group of 1015 11-12-yr-old schoolchildren in South Wales is presented. The mean number of teeth erupted was 21.8 with a distribution pattern reflecting continuing eruption of teeth at this age. Almost equal numbers of contralateral and opposing tooth types were present with exceptions including maxillary canines and lateral incisors. DMFT, DMFS, and DFS scores were consistent with other recent studies. The mean plaque score was 2.44 and showed a normal distribution for the group. All children had gingivitis at one or more sites as evidenced by bleeding on probing, and again the distribution pattern was a normal one. The mean pocketing was 1.24 mm and there was little clinical evidence of chronic periodontitis. As expected, plaque and gingivitis showed a very high and significant correlation, with plaque and pocketing and gingivitis and pocketing having lower correlation coefficients which were nevertheless highly significant.

A clinical study comparing the width of attached gingiva and the prevalence of gingival recessions

One hundred preclinical year dental students were examined. Oral hygiene status and gingival condition were determined using the Plaque Index score (Silness & Löe 1964) and the Gingival Index score systems (Löe & Silness 1963). The width of the attached gingiva and the depth of the gingival pockets were evaluated. The gingival recessions were recorded and their heights measured from the CEJ to the gingival margin. No significant correlation was found between oral hygiene and gingival recession, oral hygiene and width of attached gingival conditions and width of attached gingiva. Only a negative correlation (P less than 0.05) was found between the width of attached gingiva and the number of gingival recessions. No statistically significant differences were observed in oral hygiene status and gingival conditions among three groups of students (without, with one and with two or more recessions, respectively). The roles of toothbrushing trauma and "adequate" width of attached gingiva in the etiology of gingival recessions are questioned.

Effect of controlled oral hygiene procedures in patients with fixed prostheses

The purpose of this study was to determine the effect of frequent recall appointments for a professional oral prophylaxis, specificaly for patients with fixed prostheses. By a dental hygienist the prophylaxis was repeated every month for a test group and twice a year for a control group (24 subjects). All patients were reexamined at 6- and 12-month intervals to reevaluate the oral health. This study demonstrated that careful professional cleaning of the teeth of patiens with fixed prostheses once every month is sufficient to maintain satisfactory oral hygiene. For the private practitioner it hardly seems realistic to organize a recall program once every month. However, professional clearning twice a year cannot guarantee oral health in all patients with fixed prostheses. Therefore further examinations over a longer period of time are necessary to determine reasonable recall intervals for the successful establishment and maintenance of oral health.

An epidemiologic survey of periodontal disease in Dutch adults

An epidemiologic survey was carried out to assess the prevalence and severity of periodontal disease in randomly selected samples of employed populations in the Netherlands. Of the 1,337 persons examined by five examiners, 19.8% were edentulous; 61% of dentate persons had intense gingivitis in an average of 2.4 segments of their mouths; 53% had pockets of 3-6 mm and a further 10.1% had pockets of greater than 6 mm. The prevalence of gingivitis and pocketing increased with increasing age and decreasing levels of education. As no measures of predicting compliance were used and because treatment philosophies differ, no reasonable assessment of treatment needs could be made.

The prevalence of periodontal disease in a selected dental population

Sixty-five dental personnel, who presented for voluntary examination at a periodontal screening center, were assessed for plaque accumulation, gingival soft tissue changes, gingival recession and pocket depth. The relationship of these parameters to one another and to a variety of oral hygiene techniques was analyzed. Positive correlations were found between pocket depth and soft tissue changes and also between some of the parameters and use of an interdental stimulator or an oral irrigating device. The nature of the results is discussed.

Methods of assessing gingival and periodontal disease: a review

There has been an effort by the dental profession working in the field of gingival and periodontal disease to find a method of recording the extent and degree of pathological change in tissues leading from gingivitis to periodontitis and to measure reversible as well as irreversible changes. It is obvious that some form of index is required and it should have the following well-defined criteria: (1) Simplicity, (2) Accuracy, (3) Quantitativeness, (4) Reproducibility, (5) Speed, (6) Objectivity, and (7) Amenability to statistical analysis. Indices, as well as determining the prevalence of disease in the group under investigation at a given period in time, must also provide information on incidence of disease, i.e. at different periods of time. Indices must also give data that make it possible to verify the nature, severity and aetiology of the disease process and to evaluate therapeutic measures. Indices yield information about the success or failure of control and prevention of disease, affecting the gingivae and the periodontal tissues. A review of methods of assessing and recording gingival and periodontal disease is presented starting from the early investigations of the century. It is shown that subsequently many variations evolved, often with the same inherent difficulties of interpretation or application. Usually the initial stages of inflammation of the gingivae are more difficult to recognize than established disease. Present methods of recording as objectively and as quickly as possible the gingival state in population groups are discussed with emphasis upon the necessity for providing effective preventive measures based upon assessment of schoolchildren.

Standardization of the epidemiologic assessment of periodontal diseases. Surveys in the South Pacific

Attempts of introducing uniform techniques for the collection of statistical data on the prevalence of periodontal diseases have been made by FDI and WHO in order to arrive at valid, reproducible, and internationally comparable results. The WHO Manual of the International Classification of Diseases. Application to Dentistry offers a five digit classification of all oral diseases for statistical purposes. In contrast to morbidity statistics, epidemiological surveys must be based on adequate samples, representative for the entire population or distinct strata thereof. FDI is actually preparing guidelines for the conduct of clinical trials in periodontal diseases, comparable to those on caries incidence, indicating the proper use of indices. For the epidemiological assessment of periodontal diseases, the WHO Basic Methods (1962, 1971) have recommended the use of simple ratios of persons affected with signs of the disease. Data collected in four extensive dental surveys in Polynesian and Melanesian populations in the South Pacific served as an example to show the variety of valid information provided by these basic methods. The main results showed an early appearance of pocket formation at ages 10 to 14, preceded in a statistically significant way by calculus formation and gingivitis. A constant pattern in the sequence of attack of the various teeth by pocket formation was shown to be specific for these island populations; males were consistently more affected than females. The character of periodontal diseases prevalent among Polynesians and Melanesians was recognized to be a "dirt pyorrhea" accompanied by progressive subgingival calculus deposition and destructive periodontitis.