Epidemiology of periodontal diseases
I-Introduction:
The epidemiology of periodontal diseases appeared around the beginning of the 20th century with the establishment of the first classifications of periodontal diseases.
Currently this science is not limited to analyzing the proportions of periodontal diseases within populations but has evolved towards an analytical description of periodontitis and the study of risk factors.
II-Definitions:
- incidence: this is the number of cases occurring per unit of population at a given time (for example the number of cases of GUN in 1999 per 100,000 adults)
- prevalence: provides information on the number of individuals affected at a given time.
- descriptive epidemiology: the distribution of the disease is established, with its frequency, in different populations and different sections of the same population
- Hypothesis formulation: Researchers develop theories that attempt to explain the distribution of disease based on the most direct causal associations
- analytical epidemiology: observations are made in order to verify the hypotheses developed from descriptive studies
- experimental epidemiology: experiments are carried out on groups of populations in order to formally establish the repeatability of the results arising from these verifications.
III-aim of the epidemiological study:
- The incidence of a disease and its frequency
- Contribute to the choice of the best diagnostic methods, therefore better defining diseases and contributing to their classification
- Identification of the extent of disease and health in a defined population
- Discover the etiology of the disease and its persistence in the community
- Evaluating the effectiveness of health programs
- Estimate therapeutic needs and evaluate therapeutic methods
- Studying long-term evolution through epidemiological surveillance
IV- Indices in periodontics:
Periodontal indices have been proposed to meet the needs of therapists for the objective assessment and documentation of periodontal disease severity, its etiology, risk factors and of course to conduct valid epidemiological studies.
An index must meet the following criteria:
- the measurement of the index must be sensitive and specific
- be simple to use and interpret
- require a minimum of time
- inexpensive to use
- must not be uncomfortable for the individual being observed
- it must be reproducible
- and statistically exploitable
- must allow comparison with other populations
- its interpretation must not lead to confusion
A- the different periodontal indices:
We can find indices that each quantify one or more clinical aspects of periodontal disease such as indices of inflammation, indices of bone lysis and periodontal destruction or even indices that give ratings relating to these two aspects. We also note indices of dental mobility and abrasion. These indices can be reversible or irreversible.
a- irreversible indices:
GLICKMAN furcation involvement index :
- 0: no furcation involvement
- 1: Alveolysis reaches the furcation area but does not pass under the common root trunk.
- 2: bone resorption under the furcation is partial, the probe penetrates the interadicular space but does not cross it.
- 3: furcation involvement is complete, the probe passes from both sides.
- 4: complete damage is accompanied by significant resorption of the interadicular bone, the entrance to the furcation is no longer hidden by the gum.
MILLER’s Recession Index
- Class 1: the lesion does not extend beyond the mucogingival junction
- Class 2: the lesion reaches or exceeds the muco-gingival junction
- Class 3: the lesion reaches or exceeds the muco-gingival junction, in addition, there is a loss of the interdental papillae and the underlying bone, but always in a coronal situation of the general recession.
- Class 4: the lesion reaches or exceeds the JMG, the loss of papillae and interdental bone reaches the same level as that of the recession.
Mobility index according to ARPA and abrasion index according to AGUEL (see clinical examination course).
b- reversible indices:
- inflammation index:
The GI of LOË and SILNESS, PMA according to SCHOUR and MASSLER,
SBI of MUHLEMAN and SON,
PBI of MUHLEMAN and SAXER
- plaque indices:
– PI of LOË and SILNESS,
– Oral Health Index Simplified OHIS by GREEN and VERMILLON
• The OHI-S ( simplified oral hygiene index ) consists of two indices: the simplified debris index (DI-S) and the simplified tartar index
(CI-S).
• The DI-S is a numerical index ranging from 0 to 3:
C 0: no debris, no coloring;
C 1: soft debris covering up to one third of the tooth surface;
C 2: soft debris covering between one third and two thirds of the tooth surface;
C 3: soft debris covering more than two-thirds of the tooth surface.
• The CI-S is also a numerical index ranging from 0 to 3:
C 0: absence of tartar;
C 1: supragingival tartar covering no more than one third of the tooth surface;
C 2: supragingival tartar covering between one third and two thirds of the tooth surface;
C 3: supragingival calculus covering more than two-thirds of the tooth surface or continuous band of subgingival calculus.
• The principle of the OHI-S is to add the scores, divide them by the number of surfaces examined, and combine the index of
debris and scale index.
– Plaque index from O’Leary et al:
It seems to be the most suitable in daily practice to assess the patient’s general level of hygiene:
• – : absence of plaque in the marginal gingival region;
• +: presence of plaque detectable by the probe and visible after staining.
number of faces with plate/number of faces observed × 100 = %.
- signs of periodontal destruction:
PI (Periodontal Index) by RUSSELL 1959:
This index is based on the signs of periodontitis and their chronology of appearance on the 4 sides of the teeth:
- 0: healthy gums.
- 1: Partially inflamed gum.
- 2: Inflamed gum around the entire tooth.
- 6: formation of a periodontal pocket.
- 8: loss of function due to tooth mobility.
This is a mixed index, it was used during epidemiological studies and allows therapeutic needs to be assessed.
V- indices of the assessment of treatment needs:
Epidemiological studies have been carried out all over the world, but each group of researchers uses indices that suit them, which has made the results difficult to compare and consequently has made it impossible to reach universal conclusions regarding the prevalence of periodontal diseases and to conclude a common preventive and therapeutic approach.
indices have been proposed based on the assessment in a uniform manner of the “needs in periodontal treatment” instead of focusing on the clinical aspects of periodontal disease , thus the PTNS index (Periodontal treatment needs system of JOHANSON et al), the PSE (Periodontal screening examination) of DEVER and the CPITN (Community periodontal index treatment need of AINAMO et al) have emerged. It is the latter that has managed to be accepted by the WHO and has helped to carry out epidemiological studies of universal value in different countries and regions of the world.
VI- Current trends in epidemiological studies of periodontal diseases:
Researchers are currently focusing on the combination of the use of biological (biological markers) and socio-economic means alongside clinical indices (CPITN) in order to identify at-risk groups and provide them with early treatment.
Conclusion:
Epidemiological studies of periodontal diseases have made it easier for researchers and clinicians to collect as much data as possible (etiological, clinical, evolutionary and preventive) on this disease and limit the damage it causes to health on an individual and public scale.
Epidemiology of periodontal diseases
Early cavities in children need to be treated promptly.
Dental veneers cover imperfections such as stains or cracks.
Misaligned teeth can cause difficulty chewing.
Dental implants provide a stable solution to replace missing teeth.
Antiseptic mouthwashes reduce bacteria that cause bad breath.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush preserves enamel and gums.