EPIDEMIOLOGY OF PERIODONTAL DISEASE

ASPECT OF NORMAL GINGIVA

CLINICAL NORMAL GINGIVA

HEAVILY PIGMENTED GINGIVA

Supragingival calculus is depicted on the buccal surfaces of maxillary molars adjacent to orifice for Stenson’s duct

Extensive supragingival calculus on the lingual surfaces of lower anterior teeth

Extensive supragingival calculus is on the lingual surfaces of lower anterior teeth

Dark pigmented deposits of subgingival calculus on the distal root of an extracted lower molar.

A lower incisor depicting a prominent root without any attached gingiva and accompanying gingival recession

A patient following the placement of a soft tissue graft to gain attached gingiva and treat the gingival recession

Overhanging margin of restoration and atrophied and inflamed gingival papilla

Marginal supragingival plaque and gingivitis

Marginal gingivitis and irregular gingival contour.

48-hour plaque growth. Generalized gingivitis at the margins of almost all teeth

Generalized marginal inflammatory lesion

Generalized diffuse inflammatory lesion

Papillary gingival enlargement

Different degrees of recession

Insertion of a probe into the gingival sulcus

Bleeding appears about 30 seconds after probing.

Heavy calculus deposits on facial surfaces of upper first molar and second premolar.

Generalized gingival bleeding

Clinically normal gingiva- probe in place

Clinically normal gingiva- profuse bleeding after 30 seconds.

Generalized marginal gingivitis

Localized diffuse gingivitis

Extent of pocket revealed by periodontal probe on mesial of central incisor

Different types of periodontal pockets

The epidemiology is the science of epidemics The epidemiology is the science of epidemics. Epidemiological methods are utilized for determining what proportion of the population at a given time is affected by a disease

The purpose of epidemiology is to increase understanding of the disease process to identify the risk factors or deteminants of disease. One of the most valuable employed in dental epidemiology is the epidemiologic index which help in defining diagnosis

A GOOD EPIDEMIOLOGY INDEX : Must be easy to use Permit the examination of many people in a short period of time

TYPES OF DENTAL INDICES 1/ Measures the number or proportion of people in a population with or without a specific condition at a specific point in time or interval of time 2/ Merasures the number of people affected and severity of the specific condition at a specific time or interval of time

INDICES I. Plaque indices II. Gingival indices III. Periodontal indices IV. Treatment needs indices

Plaque indices Plaque index Interdental hygiene index Hygiene index

Only when scraped with explorer Plaque index This index concerns thickness of plaque along the gingival margin; this plaque plays role in the etiology of gingivitis Grade Description 0 No plaque 1 Thin film of plaque at the gingival margin, visible Only when scraped with explorer 2 Moderate amount of plaque along the gingival margin; Interdental space free of plaque; Plaque visible with the naked eye. 3 Heavy plaque accumulation at the gingival margin; Interdental space filled with plaque

Gingival Index Grade Description 0 Normal gingival, no inflammation, no discoloration, no bleeding 1 Mild inflammation, slight color change, mild alteration of gingival surface No bleeding 2 Moderate inflammation, erythema, swelling, bleeding on probing, or when Pressure applied 3 Severe inflammation, severe erythema and swelling, tendency toward spontaneous Hemorrhage, some ulceration

Papilla bleeding index Grade Description 1-point 20-30 seconds after probing the mesial and distal sulcus with a periodontal probe, a single bleeding point is observed 2 -line/Points Thin film of plaque at the gingival margin, visible only when scraped with an explorer 3 -Triangle The interdental triangle becomes more or less filled with blood 4 - Drops Profuse bleeding. Immediately after probing, blood flows into the interdental area to cover portions of the tooth or gingiva

Periodontal Disease Index (PDI) 0 No inflammation, no alterations in the gingiva Gingiva 1 Mild to moderate gingivitis at some locations on the gingival margin 2 Mild to moderate gingivitis of the entire gingival margin 3 Advanced gingivitis with severe erythema, hemorrhage, ulceration Periodontium 4 Up to 3mm of attachment loss, measured from the cementoenamel junction 5 3-6 mm of attachment loss 6 More than 6 mm of attachment loss

COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS (CPITN) Code CPI TN 0 Healthy 1 Bleeding on probing I . Oral hygiene instruction 2 Supra and\or Subgingival calculus II . I+ calculus removal Iatrogenic marginal irritation 3 Shallow pockets up to 5 mm III . I+II+ complex treatment 4 Deeper pockets from 6mm

The Periodontal Screening and Recording ( PSR ) The PSR examination was developed in order to streamline the data gathering and record keeping for the screening periodontal examination

The PSR exam is patterned after the Community Periodontal Index of treatment needs (CPITN ) of the world health organization

This exam is completed with periodontal probe that has a ball at the tip and a black or colored band from 3.5-5.5mm While six sites are examined per tooth

The score for each sextant is determined and recorded

PSR Codes Code 0 : The deepest probing in the sextant is < 3.5mm The colored band on the probe remains completely visible There is no bleeding, calculus, or defective restorations The patient needs preventive care only

Code 1:The colored band on the probe remains visible There is no calculus or defective restorative margins There is bleeding at the gingival margin Plaque must be removed and the patient instructed in proper oral hygiene

Code 2: The colored band on the probe remains completely visible There is detectable calculus and or defective restorative margins Treatment consists of plaque and calculus removal, Correction of plaque retentive factors and oral hygiene instruction

Code 3: The colored band on the probe is partially submerged in the pocket

Code 4: The colored band on the probe is completely submerged at one site

Code *: An asterisk is added to the numerical sextant score when furcation involvement, mobility, muccogingival problem or recession is present