PERIODONTAL EPIDEMIOLOGY AND PERIODONTAL TREATMENT NEEDS...
Transcript of PERIODONTAL EPIDEMIOLOGY AND PERIODONTAL TREATMENT NEEDS...
PERIODONTAL EPIDEMIOLOGY AND PERIODONTAL TREATMENT NEEDS IN EUROPE
ISTVAN GERA Semmelweis University Department of Periodontology Budapest, Hungary
PERIODONTAL EPIDEMIOLOGY AND PERIODONTAL TREATMENT NEEDS IN EUROPE
ISTVAN GERA Semmelweis University Department of Periodontology Budapest, Hungary
Periodontal disease is a group of etiologically closely related different diseases with different
natural course, prognosis and response to conventional therapy
Periodontal disease is a group of etiologically closely related different diseases with different
natural course, prognosis and response to conventional therapy
Most forms of gingivitis has not been regarded as disease rather as a
manifestation of the effective host defense against plaque
Disease definitions can be based on single clinical sign (i.e. bleeding on probing, deep pocket) or on a combination of different signs and symptoms
Disease definitions can be based on single clinical sign (i.e. bleeding on probing, deep pocket) or on a combination of different signs and symptoms
PERIODONTAL DISEASES 1. CHRONIC PERIODONTITIS
2. AGGRESSIVE PERIODONTITIS
3. PERIODONTITIS AS A MANIFESTATION OF SYSTEMIC DISEASES
4. NECROTIZING PERIODONTAL DISEASES
5. ABSCESSES OF THE PERIODONTIUM
6. PERIODONTITIS ASSOCIATED WITH ENDODONTIC LESIONS
7. DEVELOPMENTAL OR ACQUIRED DEFORMITIES AND CONDITIONS
- -
The international Workshop for a Classification of Periodontal Diseases and Conditions Ann Periodontol 1999; 4:1-7
The present periodontal condition can be assessed on a two level approach.
The present periodontal condition can be assessed on a two level approach.
Detailed elaborate periodontal epidemiological studies
have been conducted in the USA and many Scandinavian and in some W. European countries but these kind of studies and reports are not available from many Western European and Eastern European countries
Detailed elaborate periodontal epidemiological studies
have been conducted in the USA and many Scandinavian and in some W. European countries but these kind of studies and reports are not available from many Western European and Eastern European countries
Detailed elaborate periodontal epidemiological studies have been conducted in many Scandinavian and W. European countries
Detailed elaborate periodontal epidemiological studies have been conducted in many Scandinavian and W. European countries
Söder PO, Jin LJ, Söder B, Wikner S, Periodontal st atus in an urban adult population in Sweden. Comm Dent Oral Epidemiol 1994 22: 106-111.
Kallestal C, Mattson L. Marginal bone loss in 16-ye ar-old Swedish adolescents in 1975 and 1988. J Clin Periodontol 1991;18:740-743
Sheiham A, Smales FC, Cushing AM, Cowell CR. Change s in periodontal health in a cohort of British workers over a 14-year period. Brit Dent J 1986;160: 125-127.
Schürch E, Jr. Minder CE, Lang NP, Geering AH. Peri odontal conditions in a randomly selected population in Switzerland Comm Dent Oral Epidemiol 1988; 16: 181-186.
Miller AJ, Brunell JA, Carlos GP, Brown LJ, Löe H. Oral health of United States adults, national findings. NIH publication 1987; 87-2868.
The less complex but internationally used CPITN data
available from the WHO Data Bank can be used to compare the periodontal conditions in the two parts of the European
Continent
The less complex but internationally used CPITN data
available from the WHO Data Bank can be used to compare the periodontal conditions in the two parts of the European
Continent
WHO PROBE CPITN
CPI - CPITN INDEX
BY SEXTANS ONLY THE HIGHEST SCORES ARE RECORDED
0 – HEALTHY
1 – INITIAL GINGIVITIS
2 – GINGIVITIS + CALCULSU PPD > 3,5 mm
3 – MILD PERIODONTITIS PPD 3,5 -5,5 mm
4 – SEVERE PERIODONTITIS PPD <5,5 mm
The The proportionproportion ofof 3535--44 44 yearyear old old subjectssubjects withwith deepdeepperiodontalperiodontal pocketspockets –– CPITN 4CPITN 4
21 21 16 16 1818858511SpainSpain
16161111131385/8885/8822UKUK
171710101313878711EstoniaEstonia
1515114485/9185/9122HungaryHungary
343477161686/9086/9033PolandPoland
10106688848411PortugalPortugal
10106688838311NorvayNorvay
1111227781/8681/8633NetherlandsNetherlands
18181010141483/8583/8522ItalyItaly
44112289/9089/9011IrelandIreland
202066121285/8885/8822GreeceGreece
191988131385/9285/921010GermanyGermany
24241010161685/8985/8955FranceFrance
99447782/8382/8311FinlandFinland
UCLUCLLCLLCLMeanMean %%periodperiodNo No ofofstudiesstudies
countrycountry
CPITN index does not measure attachment loss - the cumulative effect of periodontal
destruction.
CPITN index does not measure attachment loss - the cumulative effect of periodontal
destruction.
Interpretation of periodontal prevalence and severity data based on conventional and CPITN scoring system
Interpretation of periodontal prevalence and severity data based on conventional and CPITN scoring system
Schürch E, Jr. Minder, C.E., Lang, N.P. & Geering, A.H. Comparison of clinical periodontal parameters with the Community Periodontal Index for Treatment Needs (CPITN) data. Schweitzerischer Monatsschirft Zahnmedizin 1990; 100: 408-411.
Schürch E, Jr. Minder, C.E., Lang, N.P. & Geering, A.H. Comparison of clinical periodontal parameters with the Community Periodontal Index for Treatment Needs (CPITN) data. Schweitzerischer Monatsschirft Zahnmedizin 1990; 100: 408-411.
CONVENTIONAL PROBING
DEPTH PER SITES
CPITN SCORING SYSTEM
< 3 mm 72% PERIODONTALLY HEALTHY 3 %
4-6 mm 26 % AT LEAST ONE '3' SEXTANT 42%
> 6 mm 2 % AT LEAST ONE '4' SEXTANT 55 %
Periodontal disease in
children and adolescents
Periodontal disease in
children and adolescents
Prevalence of juvenile periodontitis (agressive) (JP)Prevalence of juvenile periodontitis (agressive) (JP)
WESTERN EUROPE SAMPLE SIZE AGE PREVALENCE EASTERN
EUROPE
FINNLAND (SAXEN 1980)
8096 16 0.1 %
NO DATA
SWISS (KRONAUER 1986)
7604 16 0.1%
UNITED KINGDOM (SAXBY 1987) 7266 0.1%
ALVEOLAR BONE LOSS IN SWEDISH 16-YEAR-OLDS IN 1975 AND 1988ALVEOLAR BONE LOSS IN SWEDISH 16-YEAR-OLDS IN 1975 AND 1988
KALLESTAL, C., MATTSON l.: Marginal bone loss in 16-year-old Swedish adolescents in 1975 and 1988. J. Clin Periodontol 1991;18: 740-743
LOSS3,5%
NO96,5%
LOSS1,0%NO
99,0%
1975 1988
CPITN scores in Hungary in 1985 and 1991.CPITN scores in Hungary in 1985 and 1991.
WHO pathfinder studiesWHO pathfinder studies
Czukor J.: National Oral Health Pathfinder surveys in Hungary in the years 1985 and 1991. Fogorv. Szl. 1994; 87: 223-235
CPITN scores 12 year old 12 year old 35-44 year old 35-44 year old
1985 1991 1985 1991
Deep pocket (CPITN 4) 0,1 0 8 2,3
3-5mm Pocket (CPITN 3) 4,1 0 26,4 15,41
Calculus (CPITN 2) 30,9 30,1 50,8 71,3
Initial gingivitis (CPITN 1) 38,5 30,8 7,6 6,8
Healthy (CPITN 0) 26,2 39,1 5 4,3
PERIODONTAL CONDITION OF 12 YEAR OLD HUNGARIANSPERIODONTAL CONDITION OF 12 YEAR OLD HUNGARIANS
WHO PATHFINDER SURVEY 1996WHO PATHFINDER SURVEY 1996
Szöke J, Petersen PE.: Oral health of children. National situation based on the recent epidemiological surveys Fogorv. Szl. 1998; 91: 305-314.
LOCATIONHEALTHY GINGIVA
% CPITN = 0GINGIVITIS %
CPITN =1CALCULUS %
CPITN =2
BUDAPEST 31 39 30
DEBRECEN 28 36 36
MISKOLC 16 50 34
SZEGED 26 42 32
SZOMBATHELY 40 30 30
RURAL AREA
BÓLY 46 44 10
JÓZSA 36 38 26
MÓRAHALOM 22 48 30
SZIKSZÓ 40 44 16
TISZAVASVÁRI 16 58 26
PERIODONTAL CONDITION OF 12- YEAR OLD HUNGARIANSPERIODONTAL CONDITION OF 12- YEAR OLD HUNGARIANS
WHO PATHFINDER SURVEY 1996WHO PATHFINDER SURVEY 1996
Szöke J, Petersen PE.: Oral health of children. National situation based on the recent epidemiological surveys Fogorv. Szl. 1998; 91: 305-314.
HEALTHY30,6%
GINGIVAL BLEEDING37,8%
CALCULUS31,6%
HEALTHY 25,5%
GINGIVAL BLEEDING41,5%
CALCULUS33,0%
BOYS GIRLS
Periodontal condition of Polish children and adolescents Periodontal condition of Polish children and adolescents CPITN surveysCPITN surveys
Kaczmarczyk-Stachowska A, Knychalska-Karwan Z, Chomyszyn-Gajewska M et al.: Assessment of the periodontal condition and therapeutic needs by the CPITN index in children aged 12 years in the province of Cracow. Czas-Stomatol 1990; 43: 305-308.
Szpringer-Nodzak M, Moszczenska-Cieslikowska B, Remiszewszki A, Gieorgijewska J.: Assessment of the condition of the periodontium in children aged 12 years using the periodontal treatment needs index Czas-Stomatol 1989; 42: 273-278.
Szpringer-Nodzak M, Moszczenska-Cieslikowska B, Remiszewski A, Giergijewsa J.: Estimation of the periodontal state in seven-year old children by means of CPITN Index for periodontal treatment needs. Czas-Stomatol 1989; 42: 74- 79.
datesize of the surveyed
groupage healthy
CPITN 0 CPITN 1 CPITN 2 CPITN 3
1990 180 12 24,44% 30,56% 45% 0%
1989 180 12 18,9% 63,3% 17,8% 0%
1989 2389 7 40,5% 59% 0,5% 0%
PERIODONTAL CONDITION OF POLISH CHILDREN AND ADOLESCENTS
Periodontal status of apprenticesPeriodontal status of apprentices
3011 students of vocational schools in Rostock3011 students of vocational schools in Rostock
Oral Health status of apprentices Maiwald Hj., Kruger A., Schwarz M, Woskow I.: Stomatol-DDR. 1990; 40:81-82
CPITN
Degree 0 55,6%
Degree 1 33,5%
Degree 2 10,3%
Degree 3 0,6%
Degree 4 0,0%
Periodontal status of 15-year-olds in LatviaPeriodontal status of 15-year-olds in Latvia
506 SCHOOLCHILDREN 506 SCHOOLCHILDREN
Oral Health in Latvian 15-year-olds Bjarnason S, Berzina S, Care R, Kackevica I, Rence I.: Eur.J Oral Sci 1995; 103: 274-279.
CPITN
Degree 0 9,3%
Degree 1 38,7%
Degree 2 26,1%
Degree 3 25,9%
Degree 4 0,0%
Several studies were conducted in the 15-to-19 age group using CPITN Index system in Central and Eastern Europe
- Bulgaria (Sharkov & Atanassov 1998),
- Croatia (Plancak & Aurer-Kozelj 1992), - East Germany (Fröhlich 1990, Gaengler et al. 1988, Kozlik 1991 , Mainwald &
Engelkensmeier 1990, Mengel 1993), - Hungary (Czukor,1994, Madlena et al. 1993, Madlena et al. 1995, Szőke & Petersen 1998) ,
- Latvia (Bjarnason 1995) , - Poland (Szpringer-Nodzak et al. 1989, Szpringer-Nodzak et al. 1989, Kaczmarczyk- Stachowska et al. 1990, Knychalska-Karwan et al. 1990),
- Russia (Skliar et al. 1991)
- Slovenia (Skaleric et al. 1989).
Several studies were conducted in the 15-to-19 age group using CPITN Index system in Central and Eastern Europe
- Bulgaria (Sharkov & Atanassov 1998),
- Croatia (Plancak & Aurer-Kozelj 1992), - East Germany (Fröhlich 1990, Gaengler et al. 1988, Kozlik 1991 , Mainwald &
Engelkensmeier 1990, Mengel 1993), - Hungary (Czukor,1994, Madlena et al. 1993, Madlena et al. 1995, Szőke & Petersen 1998) ,
- Latvia (Bjarnason 1995) , - Poland (Szpringer-Nodzak et al. 1989, Szpringer-Nodzak et al. 1989, Kaczmarczyk- Stachowska et al. 1990, Knychalska-Karwan et al. 1990),
- Russia (Skliar et al. 1991)
- Slovenia (Skaleric et al. 1989).
In a comprehensive overview of 103 CPITN surveys of teenagers (Miyazaki et al.1991) pointed out that the most frequent periodontal findings all over the World were the presence of supragingival calculus, and gingival bleeding.
The severity and frequency of gingivitis was much more severe in non - industrialized than in industrialized countries and regions
In a comprehensive overview of 103 CPITN surveys of teenagers (Miyazaki et al.1991) pointed out that the most frequent periodontal findings all over the World were the presence of supragingival calculus, and gingival bleeding.
The severity and frequency of gingivitis was much more severe in non - industrialized than in industrialized countries and regions
Periodontal disease in
adults
Periodontal disease in
adults
OBSERVED PERIODONTAL CONDITIONS MEASURED BY CPITN A T AGE 35-44OBSERVED PERIODONTAL CONDITIONS MEASURED BY CPITN A T AGE 35-44
WHO: Global Oral Data Bank WESTERN EUROPEAN COUNTRIESWHO: Global Oral Data Bank WESTERN EUROPEAN COUNTRIESFINLAND 1982FRANCE 1987FRANCE 1988FRANCE 1989
W GERMANY 1985W GERMANY 1986W GERMANY 1990
IRELAND 1989ITALY 1985
NETHERLANDS 1983NETHERLANDS 1986
NORWAY 1983U.K. 1985
0% 20% 40% 60% 80% 100%
0
1
2
3
4
OBSERVED PERIODONTAL CONDITIONS MEASURED BY CPITN A T AGE 35-44OBSERVED PERIODONTAL CONDITIONS MEASURED BY CPITN A T AGE 35-44
WHO: Global Oral Data Bank CENTRAL-EASTERN EUROPEAN COUNTRIESWHO: Global Oral Data Bank CENTRAL-EASTERN EUROPEAN COUNTRIES
GDR 1985GDR 1986GDR 1987
HUNGARY 1985HUNGARY 1991
POLAND 1986POLAND 1987
BYELORUSSIA 1986ESTONIA 1987
YUGOSLAVIA 1986YUGOSLAVIA 1987YUGOSLAVIA 1987
0% 20% 40% 60% 80% 100%
0
1
2
3
4
WHO: Global Oral Data Bank WESTERN EUROPEAN COUNTRIESWHO: Global Oral Data Bank WESTERN EUROPEAN COUNTRIES
PERCENTAGE OF SUBJECTS WITH HEALTHY PERIODONTIUMPERCENTAGE OF SUBJECTS WITH HEALTHY PERIODONTIUM
AGE GROUP 35-44 YEARS
FINLAND 1982FRANCE 1987FRANCE 1988FRANCE 1989
W GERMANY 1985W GERMANY 1989W GERMANY 1991
GREECE 1985IRELAND 1989
ITALY 1985NETHERLANDS 1983NETHERLANDS 1986
NORWAY 1983PORTUGAL
SPAINU.K. 1985
0 5 10 15 20
HEALTHY
WHO: Global Oral Data Bank CENTRAL-EASTERN EUROPEAN COUNTRIES
WHO: Global Oral Data Bank CENTRAL-EASTERN EUROPEAN COUNTRIES
PERCENTAGE OF SUBJECTS WITH HEALTHY PERIODONTIUMPERCENTAGE OF SUBJECTS WITH HEALTHY PERIODONTIUM
AGE GROUP 35-44 YEARS
EAST GERMANY 1985EAST GERMANY 1986EAST GERMANY 1987
EAST GERMANYESTONIA 1987
HUNGARY 1985HUNGARY 1991
LATVIA 1993POLAND 1987POLAND 1990
ROMANIA 1997SLOVENIA 1987
YUGOSLAVIA 1987
0 2 4 6 8 10
HEALTHY
WHO: Global Oral Data Bank WESTERN EUROPEAN COUNTRIESWHO: Global Oral Data Bank WESTERN EUROPEAN COUNTRIES
PERCENTAGE OF SUBJECTS WITH DESTRUCTIVE PERIODONTITIS (AT LEAST ONE SEXTANT WITH CPITN 4 ) PERCENTAGE OF SUBJECTS WITH DESTRUCTIVE PERIODONTITIS (AT LEAST ONE SEXTANT WITH CPITN 4 )
AGE GROUP 35-44 YEARS
FINLAND 1988FRANCE 1987FRANCE 1988FRANCE 1989
W GERMANY 1985W GERMANY 1989W GERMANY 1991
GREECE 1985IRELAND 1989
ITALY 1985NETHERLANDS 1983NETHERLANDS 1986
NORWAY 1983PORTUGAL 1984
SPAIN 1993U.K. 1985
0 5 10 15 20 25
DESTRUCTIVE
WHO: Global Oral Data Bank CENTRAL-EASTERN EUROPEAN COUNTRIES
WHO: Global Oral Data Bank CENTRAL-EASTERN EUROPEAN COUNTRIES
PERCENTAGE OF SUBJECTS HAVING AT LEAST ONE SEXTANT WITH DESTRUCTIVE PERIODONTAL DISEASEPERCENTAGE OF SUBJECTS HAVING AT LEAST ONE SEXTANT WITH DESTRUCTIVE PERIODONTAL DISEASE
AGE GROUP 35-44 YEARS
EAST GERMANY 1985EAST GERMANY 1986EAST GERMANY 1987
EAST GERMANYESTONIA 1987
HUNGARY 1985HUNGARY 1991
LATVIA 1993POLAND 1987POLAND 1990
ROMANIA 1997SLOVENIA 1987
YUGOSLAVIA 1987
0 10 20 30 40 50 60
DESTRUCTIVE
OBSERVED PERIODONTAL CONDITIONS MEASURED BY CPITN AT AGE 55-64OBSERVED PERIODONTAL CONDITIONS MEASURED BY CPITN AT AGE 55-64
WHO: Global Oral Data Bank WESTERN EUROPEAN COUNTRIES 1991.WHO: Global Oral Data Bank WESTERN EUROPEAN COUNTRIES 1991.
W GERMANY 1985
W GERMANY 1990
IRELAND 1989
ITALY 1985
NETHERLANDS 1986
U.K. 1985
0% 20% 40% 60% 80% 100%
0
1
2
3
4
45%
34%
20%
17%
15%
3%
Miyazaki analyzing 100 CPITN studies carried out in more than 50
countries found that severe periodontitis affects approximately
10-15% of most population irrespective of its geographic, ethnic
or socio-economic background. (Miyazaki et al. 1991)
Miyazaki analyzing 100 CPITN studies carried out in more than 50
countries found that severe periodontitis affects approximately
10-15% of most population irrespective of its geographic, ethnic
or socio-economic background. (Miyazaki et al. 1991)
The The proportionproportion ofof 3535--44 44 yearyear old old subjectssubjects withwith shallowshallowperiodontalperiodontal pocketspockets ––CPITN 3CPITN 3
4343882121858511SpainSpain
70703838545485/8885/8822UKUK
585848485353878711EstoniaEstonia
32321313212185/9185/9122HungaryHungary
51511818323286/9086/9033PolandPoland
424234343838848411PortugalPortugal
606053535757838311NorvayNorvay
62624444535381/8681/8633NetherlandsNetherlands
52523131414183/8583/8522ItalyItaly
17171010131389/9089/9011IrelandIreland
29292222252585/8885/8822GreeceGreece
54543535454585/9285/921010GermanyGermany
38381313232385/8985/8955FranceFrance
36362424292982/8382/8311FinlandFinland
UCLUCLLCLLCLmeanmeanperiodperiodNo No ofofstudiesstudies
countrycountry
The The proportionproportion ofof 3535--44 44 yearyear old old subjectssubjects withwith deepdeepperiodontalperiodontal pocketspockets –– CPITN 4CPITN 4
21 21 16 16 1818858511SpainSpain
16161111131385/8885/8822UKUK
171710101313878711EstoniaEstonia
1515114485/9185/9122HungaryHungary
343477161686/9086/9033PolandPoland
10106688848411PortugalPortugal
10106688838311NorvayNorvay
1111227781/8681/8633NetherlandsNetherlands
18181010141483/8583/8522ItalyItaly
44112289/9089/9011IrelandIreland
202066121285/8885/8822GreeceGreece
191988131385/9285/921010GermanyGermany
24241010161685/8985/8955FranceFrance
99447782/8382/8311FinlandFinland
UCLUCLLCLLCLMeanMean %%periodperiodNo No ofofstudiesstudies
countrycountry
CPITN scores in Hungary in 1985 and 1991.CPITN scores in Hungary in 1985 and 1991.
WHO pathfinder studiesWHO pathfinder studies
Czukor J.: National Oral Health Pathfinder surveys in Hungary in the years 1985 and 1991. Fogorv. Szl. 1994; 87: 223-235
CPITN scores 12 year old 12 year old 35-44 year old 35-44 year old
1985 1991 1985 1991
Deep pocket (CPITN 4) 0,1 0 8 2,3
3-5mm Pocket (CPITN 3) 4,1 0 26,4 15,41
Calculus (CPITN 2) 30,9 30,1 50,8 71,3
Initial gingivitis (CPITN 1) 38,5 30,8 7,6 6,8
Healthy (CPITN 0) 26,2 39,1 5 4,3
17%
23%
7% 8%
44%
22%20%
9%5%
0%5%
10%15%20%25%30%35%40%45%
egészséges vérzés fogkő 3,5-5,5 5,5-
CPITN
férfi
nő
healthy bleeding calculus 3,5 mm 5,5 mm
male
female
Hermann P., Faluhelyi P., Kaán B., Borbély J., Madléna M 2005.
AVERAGE CPITN SCORES IN HUNGARY
The prevalence of persons who have as highes CPITN score in the representative eastern German populat ionThe prevalence of persons who have as highes CPITN score in the representative eastern German populat ion
Periodontal health of the population in estern Germany (former GDR)Mengel, R., Koch, MR, Pfeifer C, Flores-de-Jacoby L: J. Clin Periodontol 1993; 20:752-755.
Age group Healthy CPITN 0
Bleeding CPITN 1
Calculus CPITN 2
Shallow pockets CPITN 3
Deep pockets CPITN 4
15-19 years 6,9% 10,6% 10,6% 62,4% 9,5%
35-44 years 0,4% 2,2% 2,9% 39,6% 54,9%
45-54 years 0,0% 0,7% 2,2% 28,7% 68,5%
Treatment needs (TN) of the examined eastern German populationTreatment needs (TN) of the examined eastern German population
Periodontal health of the population in estern Germany (former GDR) Koch, MR, Pfeifer C, Flores-de-Jacoby L: J. Clin Periodontol 1993; 20:752-755.
Age group TN 0 TN 1 TN 2 TN 3
15-19 years 6,9% 93,1% 82,5% 9,5%
35-44 years 0,4% 99,6% 97,4% 54,9%
45-54 years 0,0% 100% 99,3% 68,5%
A national survey carried out in the former GDR, (now eastern part of Germany ) showed marked differences between the two parts of the unified Germany
(Mengel et al. 1993).
A national survey carried out in the former GDR, (now eastern part of Germany ) showed marked differences between the two parts of the unified Germany
(Mengel et al. 1993).
Both western and eastern Germans had had very severe periodontal conditions.
Severe forms of periodontitis (CPITN> 6mm) were observed in 17% (West) and 25% (East) of adults in the age group 35-44 years.
The differences between the two proportions were statistically significant
(Mengel et al. 1993).
Both western and eastern Germans had had very severe periodontal conditions.
Severe forms of periodontitis (CPITN> 6mm) were observed in 17% (West) and 25% (East) of adults in the age group 35-44 years.
The differences between the two proportions were statistically significant
(Mengel et al. 1993).
Distribution of degrees of severity of periodontitis (maxima) in West Germany in 1989 and East Germany in 1992.
Distribution of degrees of severity of periodontitis (maxima) in West Germany in 1989 and East Germany in 1992.
Oral health in representative samples of Germans examined in 1989 and 1992 Micheelis W. and Bauch J.: Comm Dent Oral Epidemiol 1996; 24: 62-67
Age groups overall (%) West (%) East (%)
45-54 years
Degree 0 2,4 2,8 0,5
Degree 1 11,2 9 4,4
Degree 2 20,4 20,2 19,9
Degree 3 46,8 47,6 41,4
Degree 4 22,3 20,5 28,6
In Romania according to a national survey carried out among industrial workersno sextant with CPITN score 4 occurred in the age group of 35-44 years, but just 1% had healthy periodontium in the same age group, and most of the people had bad oral hygiene. (Petersen & Tanase 1997 )
In Romania according to a national survey carried out among industrial workersno sextant with CPITN score 4 occurred in the age group of 35-44 years, but just 1% had healthy periodontium in the same age group, and most of the people had bad oral hygiene. (Petersen & Tanase 1997 )
Distribution of Romanian industrial emplyees by maximum CPITN in relation to age
Distribution of Romanian industrial emplyees by maximum CPITN in relation to age
Percentage of person with highest CPITN scores(%)Percentage of person with highest CPITN scores(%)
Petersen P.E., Tanase M.: Oral health status of an industrial population in RomaniaInt Dent J 1997; 47: 194-198
Age group Healthy (0)
Bleeding (1)
Calculus (2)
Pockets 4-5mm(3)
Pockets 6<mm (4)
18-24 yrs 5,3 57,9 36,8 0 0
25-34 yrs 2,1 22,7 72,2 0 0
35-44 yrs 1 20,2 72,1 6,7 0
45< yrs 1,4 11,1 47,2 36,1 4,2
In Slovenia calculus and shallow pockets were present in 57,4% (CPITN-3) and deep pockets (CPITN-4) in 20,3% of the examined subjects( Skaleric 1989).
In Slovenia calculus and shallow pockets were present in 57,4% (CPITN-3) and deep pockets (CPITN-4) in 20,3% of the examined subjects( Skaleric 1989).
In Poland there have been many CPITN surveys published in the Polish dental literature.
The prevalence of healthy subjects in the age group 35-44 years varied between 0.66% to 7%, and 15-21% of the population needed special comprehensive periodontal treatment because of having advanced disease ( Banach & Janczuk 1990, Janczuk et al. 1988a, Janczuk et al. 1988b, Dembowska 1995, Bratthal et al. 1988, Knychalska-Karwan et al. 1988 ) .
In Poland there have been many CPITN surveys published in the Polish dental literature.
The prevalence of healthy subjects in the age group 35-44 years varied between 0.66% to 7%, and 15-21% of the population needed special comprehensive periodontal treatment because of having advanced disease ( Banach & Janczuk 1990, Janczuk et al. 1988a, Janczuk et al. 1988b, Dembowska 1995, Bratthal et al. 1988, Knychalska-Karwan et al. 1988 ) .
Periodontal condition of the age group 35-44 years in PolandPeriodontal condition of the age group 35-44 years in Poland
Dembowska E.: Evaluation of periodontal status and periodontal treatment needs in persons aged 35-44 in Poland. Ann Acad Med Stetin 1995;41: 245-258.
datesize of the surveyed
group
healthy CPITN 0
Severe periodontitis
CPITN 4
1995 1380 7,1% 15%
A survey from the Czech Republic indicated that the prevalence of periodontitis was relatively very high among dental students, and 10% of the 5th year dental students needed periodontal surgery (Doubravsky 1990 ).
A survey from the Czech Republic indicated that the prevalence of periodontitis was relatively very high among dental students, and 10% of the 5th year dental students needed periodontal surgery (Doubravsky 1990 ).
Periodontal condition of the dental students in the Czech RepublicPeriodontal condition of the dental students in the Czech Republic
5th year dental students5th year dental students
Condition of the periodontium of medical students, Palacky University, Olomouc, by means of CPITN Index Doubrevsky V.: Prakt Zubn Lek 1990; 38: 261-264
datesize of the surveyed
group
severe periodontitis
CPITN 4
1990 126 10%
Periodontal condition of the dental students in Jagiellonian University in Cracow Poland Periodontal condition of the dental students in Jagiellonian University in Cracow Poland
dentistry students 120 Aged 23-27 dentistry students 120 Aged 23-27
Oral health state in dentistry students of Medical College, Jagiellonian University in Cracow Stypulkowska J, et al- Przegl Lek. 2003;60 Suppl 6:122-5.
datesize of the surveyed
group
severe periodontitis
CPITN 4healthy
2003 120 0% 60%
The percentage of subjects of the 35 to 44 years age group with minimum one deep pockets is ranging between 2 % and 40 % in Central Europe (Pilot 1996, Pilot 1998, Pilot & Miyazaki 1991, Me gel et al 1993).
The prevalence of deep pockets are lower in Western Europe ranging from 2%to 25% (Pilot 1996, Pilot 1998, Pilot & Miyazaki 1991, Me ngel et al. 1993 ,
Michealis & Bauch 1996)
The percentage of subjects of the 35 to 44 years age group with minimum one deep pockets is ranging between 2 % and 40 % in Central Europe (Pilot 1996, Pilot 1998, Pilot & Miyazaki 1991, Me gel et al 1993).
The prevalence of deep pockets are lower in Western Europe ranging from 2%to 25% (Pilot 1996, Pilot 1998, Pilot & Miyazaki 1991, Me ngel et al. 1993 ,
Michealis & Bauch 1996)
If only the prevalence of periodontal inflammations accompanied with irreversible periodontal attachment loss are our concern only some 10-20 % of the adult population
suffers with disease all over the World Pilot T, Miyazaki H, Global results: 15 years of C PITN epidemiology Int Dent J 1994 44: 553-560
If only the prevalence of periodontal inflammations accompanied with irreversible periodontal attachment loss are our concern only some 10-20 % of the adult population
suffers with disease all over the World Pilot T, Miyazaki H, Global results: 15 years of C PITN epidemiology Int Dent J 1994 44: 553-560
Pilot T, Miyazaki H, Global results: 15 years of CPITN epidemiology Int Dent J 1994 44:553-560
Prevalence data alone is of limited value in periodontal epidemiology. The extent and severity describes
much better the impact of the disease on the healthcare system.
If only the prevalence of periodontal inflammations accompanied with irreversible periodontal attachment loss are our concern only some 10-20 % of the adult population
suffers with disease all over the World Pilot T, Miyazaki H, Global results: 15 years of C PITN epidemiology Int Dent J 1994 44: 553-560
If only the prevalence of periodontal inflammations accompanied with irreversible periodontal attachment loss are our concern only some 10-20 % of the adult population
suffers with disease all over the World Pilot T, Miyazaki H, Global results: 15 years of C PITN epidemiology Int Dent J 1994 44: 553-560
Most of the gingivitis does not progress to periodontitis
Most of the gingivitis does not progress to periodontitis
despite of the remarkable high plaque and calculus scores just a relatively small portion of the subjects followed up developed deep periodontal pockets and severe attachment loss
Löe H, Anerund A, Boysen H et al. Natural history of periodontal disease in man. Rapid, moderate and no loss of attachment in S ri Lanka laborers 14 to 46 years of age . J Clin Periodontol 1986; 13: 43 1- 440.
It is a difficult question
why some gingival lesions progress to advanced periodontitis and why others do not?
It is a difficult question
why some gingival lesions progress to advanced periodontitis and why others do not?
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
The early epidemiological studies confirmed that
periodontal disease was associated with dental plaque
if individuals with healthy
gingiva quit brushing their teeth clinically manifest gingivitis can develop within a short period of
time
The early epidemiological studies confirmed that
periodontal disease was associated with dental plaque
if individuals with healthy
gingiva quit brushing their teeth clinically manifest gingivitis can develop within a short period of
time
Percentage of children who brush their teeth more than once a day in the Western European countries
Percentage of children who brush their teeth more than once a day in the Western European countries
SWEDEN DENMARK GERMANY AUSTRIA NORWAY FRANCE U.K. SPAIN FINLAND CZECH REP.0
20
40
60
80
100
%
TOOTHBRUSHING MORE THAN ONCE A DAY (%)TOOTHBRUSHING MORE THAN ONCE A DAY (%)
Kuusela,S et al.. Oral hygiene habits of 11-year-old schoolchildren in 22 European countries and Canada in 1993/1994. Journal of dental Research 1997; 76: 1602-1609.
Percentage of children who brush their teeth more than once a day in the Eastern European countries
Percentage of children who brush their teeth more than once a day in the Eastern European countries
Kuusela,S et al.. Oral hygiene habits of 11-year-old schoolchildren in 22 European countries and Canada in 1993/1994. Journal of dental Research 1997; 76: 1602-1609.
CZECH REP POLAND SLOVAK REP HUNGARY ESTONIA LATVIA LITHUANIA RUSSIA SWEDEN0
20
40
60
80
100
%
TOOTHBRUSHING MORE THAN ONCE A DAY (%)TOOTHBRUSHING MORE THAN ONCE A DAY (%)
Percentage of children who floss their teeth daily in the Eastern European countriesPercentage of children who floss their teeth daily in the Eastern European countries
CZECH REP SLOVAK REP HUNGARY NORWAY0
5
10
15
20
DAILY FLOSSING (%)
Kuusela,S et al.. Oral hygiene habits of 11-year-old schoolchildren in 22 European countries and Canada in 1993/1994. Journal of dental Research 1997; 76: 1602-1609.
Hermann P., Faluhelyi P., Kaán B., Borbély J., Madléna M. 2005
10,2
89,8
3,5
96,5
3,4
96,6
0,0
20,0
40,0
60,0
80,0
100,0
%
ált köz f.egy.
végzettségfogkefe-fogkrém 0
fogkefe-fogkrém 1
97,5
2,5
90,8
9,2
87,0
13,0
0,0
20,0
40,0
60,0
80,0
100,0
%
ált köz f.egy.
végzettségFogselyem 0
Fogselyem 1
THE USE OF TOOTHBRUSH AND DENTAL FLOSS BY EDUCATION
Toothbrush 0 Toothbrush 1
Floss 0
Floss 1
elem middl univ
elem middl univ
The average oral hygiene of the population in the Central and Eastern Europe is inferior to the Western European levels (Miyazaki et al. 1991).
The average oral hygiene of the population in the Central and Eastern Europe is inferior to the Western European levels (Miyazaki et al. 1991).
There is a relatively weak correlation between the amount of supragingival
dental plaque and periodontal attachment loss
There is a relatively weak correlation between the amount of supragingival
dental plaque and periodontal attachment loss
BACTERIAL PLAQUE IS A NECESSARY BUT BACTERIAL PLAQUE IS A NECESSARY BUT NOT SUFFICIENT ETIOLOGIC FACTOR IN NOT SUFFICIENT ETIOLOGIC FACTOR IN
DESTRUCTIVE PERIODONTITISDESTRUCTIVE PERIODONTITIS . . �� Destructive periodontitis affects only a relatively Destructive periodontitis affects only a relatively
small percentage of adult population small percentage of adult population
�� There is a relatively weak correlation between There is a relatively weak correlation between supragingival plaque and the severity of supragingival plaque and the severity of periodontal attachment loss periodontal attachment loss
�� Identical Identical tweentween studies indicated that the studies indicated that the manifestation of periodontal disease can be manifestation of periodontal disease can be contributed to genetic determinants at least in contributed to genetic determinants at least in 50% 50%
PLAQUE SPECIFICITY PLAQUE SPECIFICITY
IS THERE ANY PERIODONTOPATHOGENIC BIOFILM? IS THERE ANY PERIODONTOPATHOGENIC BIOFILM?
THE ABSOLUTE NUMBER AND RELETIVE PROPORTION OF PERI ODONTOPATHOGENIC POSITIVE INDIVIDUALS AMONG PATIENTS WITH PERIODONT ITIS AND HEALTHY
CONTROLS
Choi BK et al. Detection of major putative periodon topathogens in Korean advanced adult periodontitis patients using a nucleic acid-based approach J. Periodontol 2000;7 1:1387-1394
BACTERIUMCHRONIC
PERIODONTITIS (n=29) HEALTHY (n=20)
Treponema sp. 29 (100) 8 (40)
A.A. 26 (89.7) 1 (5)
P. gingivalis 29 (100) 6 (30)
Fusobacterium sp. 29 (100) 17 (85)
B. forsythus 28 (96.9) 11 (55)
P. intermedia 26 (89.7) 1 (5)
P. micros 28 (96.6) 6 (30)
THE NUMBER AND % OF INDIVIDUALS
BACTERIAL SPECIFITYBACTERIAL SPECIFITYOral Actinobacillus actinomycetemcomitans Oral Actinobacillus actinomycetemcomitans
study population findings
Natural distribution of oral A.actinomycetemcomitans in
young men with minimal periodontal disease.
1005 subgingival and extracrevicular samples from 201 male recruits,
18-25 yr old, were selectively cultivated for
A.actinomycetemcomitans.
A. a in disease group was 41%, while 23% and 27% in the minimally diseased
populations (p < 0.15).
A longitudinal study of Actinobacillus
actinomycetemcomitans in army recruits.
201 recruits, 18-25 yr old, were examined for
subgingival and extracrevicular Actinobacillus
actinomycetemcomitans.
A.a seems not to increase the risk for developing or
progressing periodontitis in this age group
Muller HP, Eger T, Lobinsky D, Hoffmann S, Zoller L
Muller HP, Zoller L, Eger T, Hoffmann S, Lobinsky D
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
The prevalence of Type I and Type II diabetes in Ce ntral and Eastern European countriesThe prevalence of Type I and Type II diabetes in Ce ntral and Eastern European countries
McCarty D., Zimmet ,P.: Diabetes 1994-2010. Global estimates and projections, Bayer AG, Leverkusen 1994.
country Type I prevalence % Type II prevalence %
world avarage 0,2 1,75
European average 0,47 3,14
European minimum 0,11 (Albania) 0,93 (Albania)
European maximum 0,91 (Sweden) 5,23 (Malta)
Austria 0,58 3,19
Hungary 0,29 2,61
Croatia 0,21 4,7
Romania 0,25 2,27
Slovekia 0,23 2,06
Slovenia 0,25 2,08
Ukraine 0,35 1,98
Yugoslavia 0,23 2,07
III. NHANES in the USA (more than 31000 people) showed the following prevalence of periodontitis III. NHANES in the USA (more than 31000 people) showed the following prevalence of periodontitis
diabetes % control %
>5mm attachment loss 30 20
>5 mm- deeper pocket 21 8,8
>3mm- gingival recession 31 22
positive bleeding on probing 63 50
The occurrence of severe periodontitis in diabetic and non diabetic population The occurrence of severe periodontitis in diabetic and non diabetic population
the prevalence of attachment loss >5mm the prevalence of attachment loss >5mm
11,0%
89,0%
5,0%
95,0%
diabetes healthy
The prevalence of Diabetes among patients with severe periodontitis and those with healthy periodontium
The prevalence of Diabetes among patients with severe periodontitis and those with healthy periodontium
13,0%
87,0%
6,0%
94,0%
periodontitis healthy periodontium
DIABETES AND PERIODONTAL DISEASE study population findings
Periodontal treatment needs in adults with diabetes in Finland
(n = 115)
Pathological pockets (CPITN 3 or 4) in 80% of subjects and 48% of
sextants (n = 627)
Oral self-care among adults with diabetes in
Finland.120 dentate individuals,
reported good oral condition was strongly
associated with frequent dental visits and less plaque and calculus
A comparison between diabetic and non-diabetic
subjects.
102 randomly sampled diabetic patients and
102 controls
Sites with advanced periodontitis were more frequent in the diabetic
group (P=0.006)
Karikoski A, Murtomaa H.
Karikoski A, Ilanne-Parikka P, Murtomaa H.
Sandberg GE, Sundberg HE, Fjellstrom CA, Wikblad KF
DIABETES AND PERIODONTAL DIABETES AND PERIODONTAL DISEASEDISEASE
0
10
20
30
40
50
60
70
CAL PPD GR BOP
DIABETICNON-DIABETIC
% PERSONS PREVALENCE OF DISEASE
DIABETES AND PERIODONTAL DIABETES AND PERIODONTAL DISEASEDISEASE
0
5
10
15
20
25
CAL PPD GR BOP
DIABETICNON-DIABETIC
% TEETH
EXTENT OF DISEASE
DIABETIC NON DIABETIC0
0,5
1
1,5
2
2,5
3
3,5
4
ODDS RETION
DIABETES AS A RISK FACTORDIABETES AS A RISK FACTOR
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
Males generally exhibit poorer oral hygiene and inferior periodontal condition than women in industrialized countries (Söder et al. 1994, Oliver et al. 1998, Albandar & Kingman
1999). Women's' oral health awareness and the frequency of dental office attendance are higher than that of males in Western Europe.
Some study from Eastern Europe indicates different tendencies.
Males generally exhibit poorer oral hygiene and inferior periodontal condition than women in industrialized countries (Söder et al. 1994, Oliver et al. 1998, Albandar & Kingman
1999). Women's' oral health awareness and the frequency of dental office attendance are higher than that of males in Western Europe.
Some study from Eastern Europe indicates different tendencies.
17%
23%
7% 8%
44%
22%20%
9%5%
0%5%
10%15%20%25%30%35%40%45%
egészséges vérzés fogkő 3,5-5,5 5,5-
CPITN
férfi
nő
healthy bleeding calculus 3,5 mm 5,5 mm
male
female
Hermann P., Faluhelyi P., Kaán B., Borbély J., Madléna M 2005.
AVERAGE CPITN SCORES IN HUNGARY
Hermann P., Faluhelyi P., Kaán B., Borbély J., Madléna M. 2005
DENTAL OFFICE ATTENDANCE BY GENDER
34%28%
64%70%
0%
10%
20%
30%
40%
50%
60%
70%
rendszeresen panasz esetén
nő
férfiFM
REGULARLY IN CASE OF PAIN
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
Genetic factors Genetic factors
Any kind of gene combination that might have effect on the development of periodontal tissues or influence the innate or specific immune reactions can be a major susceptibility risk factor in the etiology of periodontal disease
Any kind of gene combination that might have effect on the development of periodontal tissues or influence the innate or specific immune reactions can be a major susceptibility risk factor in the etiology of periodontal disease
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
Per capita tobacco consumption data from the ten leading countriesPer capita tobacco consumption data from the ten leading countries
WHO Data BankWHO Data Bank
WHO Tobacco or health, the tobacco epidemic. A global Public Health Emergency. WHO Website, Tobacco Alert, April 1996. (www.who.int/psa/ton Alert/apr 96/index.html.
Country 1990-92 1970-72 1980-82
Poland 3620 (1) 3010 (11) 3400 (6)
Greece 3590 (2) 3640 (16) 3440 (4)
Hungary 3260 (3) 2940 (13) 3320 (7)
Japan 3240 (4) 2950 (12) 3430 (4)
Rep. of Korea 3010 (5) 2370 (15) 2750 (20)
Switzerland 2910 (6) 3700 (2) 3060 (6)
Iceland 2860 (7) 2940 (14) 3230 (9)
the Netherlands 2820 (8) 3150 (6) 3290 (8)
Yugoslavia 2800 (9) 2330 (21) 3030 (12)
Smoking PeriodontitisSmoking Periodontitis
Severe destructive periodontitis is more common in smokers than in matched non smokers
The age matched smoker population shows a significantly higher average periodontal index score than non smokers
The extent and severity of periodontal bone loss is more severe in smokers than in age matched non smokers
Severe destructive periodontitis is more common in smokers than in matched non smokers
The age matched smoker population shows a significantly higher average periodontal index score than non smokers
The extent and severity of periodontal bone loss is more severe in smokers than in age matched non smokers
THE EFFECT OF TOBACCO SMOKING ON ALVEOLAR BONE LOSS (BL) AND ATTACHMENT LOSS (CAL)
BL CAL0
0,5
1
1,5
2
2,5
3
3,5
4
MALE SMOKERS
FEMALE SMOKERS
MALE NON
FEMALE NON
El-Ghorab et al. Assessment of risk for periodontal disease. II. Risk indicators for alveolar bone loss. J. Periodontol 1995;66:23-29
mm
THE RATE OF ALVEOLAR BONE LOSS RELATED TO THE AGE
10 20 30 40 50 60 70 800
20
40
60
80
NON SMOKER SMOKER
%
ÉV
Relationship between smoking and dental status
study population findings
Swedish urban population of smokers and non-smokers
1676 adults
Smokers were more aware of their
periodontal status than non-smokers.
A 10-year prospective study of tobacco smoking and periodontal health.
101 individuals
the 10-year change was significantly associated
with smoking (P <0.001).
Relationship between smoking and dental status
in 35-, 50-, 65-, and 75-year-old individuals.
35-, 50-, 65-, and 75-year-old subjects (n =
1093),
Smokers had the largest mean probing attachment loss in all
age groups.
Airila-Mansson S,
Bergstrom J, Eliasson S, Dock J.
Axelsson P, Paulander J, Lindhe J.
SmokingSmoking ––CPITNCPITN
prevalence of CPITNmaxima scores of smokersand non smokers . nem
dohányos; 2755; 59%
leszokott; 441; 10%
dohányos; 1410; 31%
nem dohányosdohányosleszokott
15,114,89,6 10,2
5,77,1
46,2
53,6
44,4
22,822,224,1
5 ,46,5
14,7
0
10
20
30
40
50
60
%
0 1 2 3 4
C P ITN
nem dohányos
dohányos
lesz oko tt
Non smoker
Smoker
Quit
Non smoker
Smoker
Quit
Hermann P., Faluhelyi P., Kaán B., Borbély J., Madléna M. 2005
THE ATTRIBUTABLE RELATIVE RISK FOR SMOKING IN THE ETIOLOGY OF DESTRUCTIVE PERIODONTITIS
RELATIVE RISK 0
0,5
1
1,5
2
2,5
3
3,5
4
NON SMOKER SMOKER
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
PERCENTAGE OF TEETH WITH > 3 mm ATTACHMENT LOSS BY AGE
Albander et al. Destructive periodontal disease in adults 30 years of age and older in the US 1988-1994 J. Periodontol 1999;70-13.
30-39 40-49 50-59 60-69 70-79 80-890
10
20
30
40
50
60
FEMALEMALE
TOTAL
%
év
PERCENTAGE OF PERSONS WITH > 4mm POCKETS BY AGE
Albander et al. Destructive periodontal disease in adults 30 years of age and older in the US 1988-1994 J. Periodontol1999;70-13
30-39 40-49 50-59 60-69 70-79 80-890
5
10
15
20
25
30
35
FEMALEMALETOTAL
%
év
PercentagePercentage ofof personspersons withwithperiodontitis periodontitis withwith ageage andand gendergender
0
10
20
30
40
50
60
70
20 30 40 50 60 70 80 90
malefemale
PercentagePercentage ofof personspersons withwith>4mm PPD >4mm PPD byby ageage andand gendergender
0
10
20
30
40
50
60
70
20 30 40 50 60 70 80
malefemale
PERIODONTITIS AND AGING
study population findings
Periodontal conditions among the old elderly: five-year longitudinal study.
57 dentate elderly participated in both baseline and follow-up
examinations,
periodontal disease in the elderly who are relatively healthy is not caused by the aging process.
Oral health in hospitalized and nonhospitalized community-dwelling
elderly patients.181 hospitalized patients
Edentulousness was observed in 66.3% of the hospitalized patients and 42.1% of the nonhospitalized
Periodontal conditions in 65-74 year old adults in France, 1995.
603 noninstitutionalized elderly subjects aged 65-74 years
The total prevalence of periodontal disease (code 3 + 4) was 31.5.
A 9-year longitudinal study of periodontal status in 70- and 79-year-old
city cohorts
1393 individuals in the County of Stockholm
The frequency of surfaces with attachment level > 3 mm increased statistically significantly from 1981
to 1990 in the older cohort. Subjects with annual visits had in general
fewer oral problems.
Ajwani S, Ainamo A.
Pajukoski H, Meurman JH, Snellman-Grohn S, Sulkava R.
Bourgeois DM, Doury J, Hescot P.
Nordstrom G, Bergman B, Borg K, Nilsson H, Tillberg A, Wenslov JH.
-
+
+
+
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
Many studies have indicated that lower income groups have a much higher prevalence of gingivitis and periodontitis than people living on a much higher living standards (Oliver et al. 1998, Micheelis & Bauch 1996) .
These can be attributed to the inferior oral hygiene, the lack of sophisticated oral hygienic aids, the inferior standards in dental care and the limited access to dental services
Many studies have indicated that lower income groups have a much higher prevalence of gingivitis and periodontitis than people living on a much higher living standards (Oliver et al. 1998, Micheelis & Bauch 1996) .
These can be attributed to the inferior oral hygiene, the lack of sophisticated oral hygienic aids, the inferior standards in dental care and the limited access to dental services
According to a survey from eastern Germany 62,4% of all people with a qualification equivalent to junior high school certificate had advanced periodontitis and none of them had healthy periodontium,while only 37.7% of the participants with university degree had advanced periodontitis (Mengel et al. 1993)
According to a survey from eastern Germany 62,4% of all people with a qualification equivalent to junior high school certificate had advanced periodontitis and none of them had healthy periodontium,while only 37.7% of the participants with university degree had advanced periodontitis (Mengel et al. 1993)
CPITN BY EDUCATION CPITN BY EDUCATION
szignificantdifferencesbetween theprevalence ofCPI degrees in differenteducation levels(p=0,000) .
0,0
5,010,0
15,020,0
25,030,0
35,040,0
45,050,0
%
0 1 2 3 4
CPITN
ált
köz
f.egy.
Hermann P., Faluhelyi P., Kaán B., Borbély J., Madléna M. 2005
TOOTHBRUSHING BY EDUCATIONTOOTHBRUSHING BY EDUCATION
16,22
3,56 2,72
28,87
20,57
15,52
44,37
65,08 66,11
9,02 9,6913,45
1,51 1,09 2,20
0
10
20
30
40
50
60
70
ált köz
f.egy
.
%
< 1x
1x
2x 3x
> 3x
The were significant differences in daily toothbrushing frequency among different educational levels (p=0,000) .
Hermann P., Faluhelyi P., Kaán B., Borbély J., Madléna M. 2005
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
Stress factors Stress factors
The role of stress in the pathogenesis of periodontal disease is rather controversial.
It is well known that stress can alter the corticosteroid production the adrenal cortex, that in turn can modulate the cellular and humoral immune reactions
The role of stress in the pathogenesis of periodontal disease is rather controversial.
It is well known that stress can alter the corticosteroid production the adrenal cortex, that in turn can modulate the cellular and humoral immune reactions
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
The low quality of restorative care, the lack of periodontal preventive approaches in the general dental practices, is a major threat to the periodontal health
The low quality of restorative care, the lack of periodontal preventive approaches in the general dental practices, is a major threat to the periodontal health
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
1. Plaque 2. Systemic conditions 3. Gender4. Genetics5. Behavior 6. Age7. Socioeconomic status 8. Stress 9. Quality of previous restorations10. Dental office attendance
These factors might have a major impact on a given population's periodontal treatment needs
According to a Swedish survey 75% of the subjects visited their dentist at least once a year and only 5% had not visited the dentist for more than 3 years (Söder et al 1994) . In Romania just 24% of the subjects visited their dentist within 12 months and 31% had never been to a dental office in their whole life (Petersen & Tanase 1997) . In Hungary only 32% of the interviewed 5000 adults visited their dentist annually, 5% never attended any dental offices and 49% of the subjects saw a dentist just in case of dental emergency (Dombi et al. 1996).
According to a Swedish survey 75% of the subjects visited their dentist at least once a year and only 5% had not visited the dentist for more than 3 years (Söder et al 1994) . In Romania just 24% of the subjects visited their dentist within 12 months and 31% had never been to a dental office in their whole life (Petersen & Tanase 1997) . In Hungary only 32% of the interviewed 5000 adults visited their dentist annually, 5% never attended any dental offices and 49% of the subjects saw a dentist just in case of dental emergency (Dombi et al. 1996).
DENTAL OFFICE ATTENDDENTAL OFFICE ATTENDAANCE BY NCE BY EDUCATIONEDUCATION
ált
köz
f.egy.
17,69
38,38 46,88
82,31
61,62
53,12
0102030405060708090
100
%
panasz
rendsz.
The frequency of dental office attendance is significantly different in different
educational levels
(p=0,000)
ER
regular
Hermann P., Faluhelyi P., Kaán B., Borbély J., Madléna M. 2005
PRESENT FOCAL THEORY PRESENT FOCAL THEORY DENTAL FOCUS
DIRECT ACUTE OR CHRONIC BACTERIAEMIA ENDOTOXINEMIA LPS
PERIODONTAL POCKET IS A FOCUS !!!!!!!!
INFECTIVE ENDOCARDITISPROSTHETIC JOINT INFECTION ATHEROSCLEROSIS
CHD STROKE
DIABETES
PREGNANCY EFFECT
MISCELLANIES :RESPIRATORYGASTROINTESTINAL
Position Paper : Periodontal disease as a potenti al risk factor for systemic diseases J Periodontol 1998; 69: 841-850.
Pregnancy
effects Pregnancy
effects Pregnancy
effects Pregnancy
effects Pregnancy
effects Pregnancy
effects Pregnancy
effects Pregnancy
effects Pregnancy
effects Pregnancy
effects
The periodontal state of mothers with preterm low birth weight (PLBW) and age matched controls
The East London Study of Maternal Chronic Periodontal Disease and Preterm Low Birth Weight Infants: Study Design and Prevalence Data by Davenport E.S. & Co. Annales of Periodontology 3: 213-221 1997
THE WORTH PERIODONTAL STATE
NORMAL BIRTH BETWEEN THE
AGE 16-44
PRETERM LOW BIRTH WEIGHT
AGE 16-44
HEALTHY PERIODONTIUM 27 0
MILD GINGIVITIS 14 1
SEVERE GINGIVITIS 30 12
SHALLOW POCKET 26 38
DEEP POCKET 3 49
GESTATIONAL AGE AND PERIODONTITIS
<28 <32 <35 <37 NORMAL0%
20%
40%
60%
80%
100%
SEVEREMILD
HEALTHY
TIME OF DELIVERY
Offenbacher S. et al: Maternal periodontitis and Pr ematurity. Part I: Obstetric outcome of prematurity and growth restriction Ann Periodontol 2001;6:164-174
1300 EXAMINED PREGNANCY
MATERNAL ANTEPARTUM PERIODONTAL STATUS
HEATHY MILD SEVERE0%
20%
40%
60%
80%
100%
<1000
1000 - 19992000 - 2499>2500
BIRTH WEIGHT (gramS)
Offenbacher S. et al: Maternal periodontitis and Pr ematurity. Part I: Obstetric outcome of prematurity and growth restriction Ann Periodontol 2001;6:164-174
1300 EXAMINED PREGNANCY
Periodontal status and preterm low birth weight : a case control studyPeriodontal status and preterm low birth weight : a case control study
59 women with preterm birth and 42 controlsConclusion : no significant differences between the groups in any aspects of the studied parameters Periodontitis was not a detectable risk facotr for PTLB
59 women with preterm birth and 42 controlsConclusion : no significant differences between the groups in any aspects of the studied parameters Periodontitis was not a detectable risk facotr for PTLB
Noack B, Klingerberg J, Weigelt J, Hoffmann T : J. Peridontol Res. 2005Noack B, Klingerberg J, Weigelt J, Hoffmann T : J. Peridontol Res. 2005
Periodontitis, a marker of risk in pregnancy for preterm birthPeriodontitis, a marker of risk in pregnancy for preterm birth
Data collected from 3738 subjects
Conclusion: there were no signficant relationship between the severity of periodontal disease ant either preterm birth or LBW.
Data collected from 3738 subjects
Conclusion: there were no signficant relationship between the severity of periodontal disease ant either preterm birth or LBW.
Dortbudak O. Eberhardt R. Ulm M, Persson GR J. Clin Periodontol 2005Dortbudak O. Eberhardt R. Ulm M, Persson GR J. Clin Periodontol 2005
A possible association between preterm birth and early periodontitisA possible association between preterm birth and early periodontitis
Case control study:41 women with preterm birth and 44 controlsConclusion:The early localized periodontitis of the patient during pregnancy can be regarded as an important risk factor for preterm birth
Case control study:41 women with preterm birth and 44 controlsConclusion:The early localized periodontitis of the patient during pregnancy can be regarded as an important risk factor for preterm birth
Radnai M. et al. J. Clin Periodontol 2004Radnai M. et al. J. Clin Periodontol 2004
CARDIOVASCULAR
DISEASESCARDIOVASCULAR
DISEASESCARDIOVASCULAR
DISEASESCARDIOVASCULAR
DISEASESCARDIOVASCULAR
DISEASESCARDIOVASCULAR
DISEASESCARDIOVASCULAR
DISEASESCARDIOVASCULAR
DISEASESCARDIOVASCULAR
DISEASESCARDIOVASCULAR
DISEASES
THE CORRELATION BETWEEN THE ATHEROSCLEROSIS (THE I NCIDENCE OF CONGESTIVE HEART DISEASES ) AND PERIODONTAL CONDIT ION
RELATIVE ODDS RATIO
STUDY CORRELATION (ODDS RATIO)
Matilla -Finland total dentition / heart attack 1,3
Matilla - Finland total dentition / atherosclerosis
1,4
Matilla-Finland total dentition / CHD incidence 1,2
DeStefano - USA plaque, periodontium / lethal CHD
1,7
Beck - USAperiodontal bone level/new
CHD 1,5
Beck - USAperiodontal bone level/
lethal CHD 1,9
Beck - USA periodontal bone level/ stroke
2,7
Joshipura - Japan missing teeth / CHD 1,7
PERIODONTITIS AND CARDIOVASCULAR - CEREBROVASCULAR DISEASES
study population findings
Periodontal disease and mortality in an aged population
364 home dwelling 75+ years of age
periodontitis doubled the risk of cardiovascular disease-related
mortality (HR 2.28,).
Periodontal disease as a risk factor for ischemic stroke.
303 acute ischemic patients vs. 300 controls
severe periodontitis ( CAL >6 mm) had a 4.3-times-higher risk
of cerebral ischemia
Oral health indicators poorly predict coronary heart disease deaths.
6527 men and women aged 30-69 years
The associations between oral health and CHD are explained
by confounding factors
Oral health status, C-reactive protein and mortality
364 subjects aged 76, 81, and 86 10 year follow-up
Periodontal disease was associated with a two-fold CVD
mortality
Ajwani S, Mattila KJ, Tilvis RS, Ainamo A.
Grau AJ, Becher H, Ziegler CM, Lichy C, Buggle F,
Tuominen R, Reunanen A, Paunio M, Paunio I, Aromaa A
Ajwani S, Mattila KJ, Narhi TO, Tilvis RS,
-
+
+
+
PERIODONTITIS AND CARDIOVASCULAR - CEREBROVASCULAR DISEASES
study population findings
Endodontic variables and coronary heart disease. Goteborg, Sweden
1056 of women in, aged between 38 - 84 years
did not reveal a significant association between
endodontically treated teeth and CHD
Oral health and cardiovascular disease in Sweden.
4811 randomly selected Swedes.
significant association between bleeding gums (odds ratio 1.60,
p=0.0017), no association between deep pockets and
known CVD
Oral health indicators poorly predict coronary heart disease deaths.
6527 men and women aged 30-69 years
The associations between oral health and CHD are explained
by confounding factors
Relationship between oral health and mortality in cardiovascular diseases.
1393 individuals in the County of Stockholm
Dental health was found to be a risk indicator of death due to
CVD, especially in combination smoking habits.
Frisk F, Hakeberg M, Ahlqwist M, Bengtsson C.
Grau AJ, Becher H, Ziegler CM, Lichy C, Buggle F,
Buhlin K, Gustafsson A, Hakansson J, Klinge B.
Jansson L, Lavstedt S, Frithiof L, Theobald H.
-
+
+
+
Is the observed association between periodontitis and atherosclerosis causal?
Based on a critical evaluation of the 14 investigations selected from a total of 21 retrieved
from the search, a causal relationship between periodontitis and atherosclerosis-related diseases
appeared possible
Kolltveit KM, Eriksen HM.Eur J Oral Sci. 2001 Aug;109(4):286-7.
MISSING TEETH
CORONARY HEART DISEASE AND STROKECORONARY HEART DISEASE AND STROKE
STRESS, DIABETES, SMOKING DIET EXUDATIVE PHENOTYPE
PERIODONTITIS CARIES
INFLAMMATORY MEDIATORS CLOTTING FACTORS
INFLAMMATORY MEDIATORS CLOTTING FACTORS
BEHAVIORAL FACTORS
BEHAVIORAL FACTORS
SMOKINGLACK OF PHYSICAL ACTIVITYOBESITY
BACTERIAEMIA
SOCIAL FACTORS STRESS
DIETARY HABITS
ACCEPTING EXTRACTION
CLAIM FOR DENTAL CARE
Joshipura et al.: Possible explanations for the tooth loss and cardiovascular disease relationship Ann. Period. 1998; 3.: 175-183, 1998
CARDIOVASCULARIS BETEGSÉGEK
DIABETESMELLITUS
KORASZÜLÉSEK
OSTEOPOROSIS
GASTRO-INTESTINALIS BETEGSÉGEK
PARODONTITIS RESPIRATORICUS BETEGSÉGEK