EPIDEMIOLOGY OF PERIODONTAL DISEASES

Epidemiology is the study of the patterns of health and disease in a population

Purposes of epidemiology
n

Establish causal mechanisms

Complete the clinical picture Identify aetiological factors n Estimate individual/population risks of the disease
n n

Explain unusual outbreaks of disease

Purposes of epidemiology
n

Determine trends in disease patterns Data for health administration and planning
Determine need for health services n Evaluate effectiveness of health services
n

Strategies for epidemiological research

n

Descriptive epidemiology
Description of distribution n Comparison of its frequency
n

Analytical epidemiology
n

Observational studies to test hypothesis resulting form descriptive studies

Strategies for epidemiological research

n

Experimental epidemiology
n

Includes clinical studies n Interpretation of clinical trials, preventive and curative and measures

Periodontal epidemiology
n

Provide data on prevalence of periodontal diseases in different populations (frequency, severity) Investigate factors involved in its aetiology including risks factors

Periodontal epidemiology
n

Provide documentation concerning the effectiveness of preventive and therapeutic measures

Prevalence is the proportion of persons affected by a disease at a specific point in time as determined by crosssectional studies.

Incidence is the rate of occurrence of a new disease in a population during a given interval of time

Epidemiologic indices
n

Indices are used to quantitate clinical conditions on a graduated scale to facilitate comparison between populations examined by the same criteria and method

Epidemiologic indices
n n

n n

Easy to use Able to define clinical conditions objectively High reproducibility Amenable to statistical analysis

Periodontal indices
n n n n n

Gingival inflammation Periodontal destruction Amount of plaque accumulated Amount of calculus present Assess treatment needs

Gingival inflammation
n

Loe & Silness 1967 (0;1;2)

n n

visual recording of colour change bleeding on probing

Gingival Sulcus Bleeding

(Ainamo & Bay ; Muhlmann & Son; Modified OLeary) n absence and presence of bleeding

Periodontal destruction
n

Periodontal Index (PI)

n

measures inflammation , pocket formation, loss of function (Score 0-8) measure attachment loss instead of pocket depths

Periodontal Disease Index (PDI)

n

Radiographic assessments

Attachment loss

Probing depth =6 mm Probing depth =9 mm Probing depth =3 mm Probing attachment Probing attachment Probing attachment level =6mm level =6mm level =6mm

Debri indices
n

n n

Simplified Oral Hygiene index Plaque indices Calculus indices

Treatment needs indices

n

Community Periodontal Index of Treatment Needs (CPITN)

n

An index system based at assessing the need for periodontal treatment large population groups

CPITN for Epidemiology

10 indexed teeth

17 16 47 46

11 31

26 27 36 37

CPITN for Treatment/Clinical

Teeth examined

17-14 47-14

13-23 43-33

24-27 34-37

CPITN
Code 0: Health Code 1: Bleeding on probing Code 2: < 3mm, presence of calculus Code 3: 4-5mm probing depths Code 4: 6mm or > TN 0: No treatment TN 1: Oral hygiene TN 2: OH, scaling

TN 4: Requires complex treatment

Case 1

1 1

0 2

0 0

Needs scaling for lower mandibular anterior sextant Needs oral hygiene for upper right posterior sextants

Case 2

4 3

0 2

3 3

n n

Needs complex treatment in upper right sextant Scaling in all but upper anterior Oral hygiene instructions

Prevalence of periodontal disease

Despite differences in design and methodology,
high prevalence of periodontal disease in adults n clear increase in prevalence with age
n

Prevalence of periodontal disease

Natural history of periodontitis (Loe et 1978)
Norwegian group n Excellent OH n Low PI and GI n No deep pockets n Minimal attachment loss n Mean CAL at 30 yrs, <1mm Sri Lankan group n Poor OH n High PI and GI n Attachment loss present at 16 yrs n Loss of teeth, CAL>10mm n Mean CAL at 30 yrs, 3mm

Prevalence of periodontal disease

Severe forms affect a minority of subjects (10-15%) Percentage of such subjects increases considerably with increasing age

Periodontal Status of Singapore Adults

Studies Population CPITN Scores (%population) 0 Ong et al 1996 Electoral roll: 774 1 2 3 4

12.4 7.2

63.0 14.0 5.7

Unpublished Constituencies: 3035

4.8

3.1

79.2 12.7 0.2

Natural history of periodontitis (Loe et 1986)

n

1970-1985
n

5 examinations conducted

Sri Lankan tea workers

Start: 480 subjects n Final :161 of original sample
n

CAL and tooth mortality measured

Natural history of periodontitis (Loe et 1986)

Rapidly Progressive Moderately Progressive No progression beyond gingivitis: 8% 81 % 11%

Natural history of periodontitis (Loe et 1986)

Loss of attachment
Rapidly Progressive Moderately Progressive No progression beyond gingivitis: 0.1-1mm 0.05-0.5mm 0.04-0.09mm

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Natural history of periodontitis (Loe et 1986)

Loss of teeth
Rapidly Progressive Moderately Progressive No progression beyond gingivitis: 12 teeth 7 teeth 0

Longitudinal data
n

Ismail et 1990
n

Over 28-year period

13.3% had an average loss of =2mm 3% showed loss of = 3mm n 2% showed loss of = 4mm
n n

Longitudinal data
n

Lindhe et al 1983
n

Over 2-year period

n

Only 3% loss > 2mm Only 11.6% showed progresssive loss of same magnitude

6 years
n

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Risk factors for periodontal disease

n n n n n n

Age? Ethnic differences Microbiologic profile Genetic predisposition Smoking Diabetes

The challenge of epidemiological research is to identify accurate determinants of the disease, i.e. risk factors for disease progression

Reading list
Chapter 2. Epidemiology of Periodontal Disease Clinical Periodntology and Implant Dentistry, Lindhe, Karring & Lang, 3rd edition; 1997

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