EPID PERIOD.ppt

8/9/2019 EPID PERIOD.ppt

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EPIDEMIOLOGI

PENYAKIT PERIODONTAL


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DENTAL EPIDEMIOLOGI :Adalah studi tentang distribusi & dinamika

penyakit gigi pada populasi dalam masyarakat

ental epidemiologi dipengaruhi oleh

Usia - kelamin

Ras/ kelompok - tempat tinggal

pekerjaan - karakter sosial

kerentanan - pemaparan thd agent spesifik

Tujuan :

> Meningkatkan pengertian ttg proses penyakituntuk mencegah dan mengontrol penyakit

period.

> unt mengembangkan cara pengontrolan &

perkembangan penyakit


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INDEKS EPIDEMIOLOGI

Penilaian unt mengkwantisasikan kondisi klinik pada

skala ukuran shg memudahkan dlm memandingkanantara populasi yg diperiksa dg kriteria ! metode yg

sama.

Kriteria Indeks:

mudah digunakandpt digunakan pada populasi dlm waktu singkatdpt menetapkan kondisi klinik seoyek mungkin

dpt digunakan unt menilai keadaan klinik unt satu atau

leih pemeriksamudah dianalisa secara statistikerhu erat secara numerik thd tingkatan keadaan

klinik dr penyakit yg spesifik


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Indeks Periodontal menilai:

". #erajat peradangan gingi$a

%. #erajat kerusakan gingi$a

&. 'anyaknya akumulasi plak

(. 'anyaknya kalkulus

Papillary Marginal ) Attachment *nde+ ,PMA-

*nde+ Periodontal *nde+ ,P* Russel

Periodontal #isease *nde+ ,P#* Ramfjord ingi$al *nde+ ,* oe ! 0illness 1ommunity Periodontal *nde+ of 2reatment 3eeds

,1P*23 dls


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Appearance

Bleeding Inflammation Points

normal no bleeding none 0

slight change in color

and mild edema withslight change in texture

no bleeding mild 1

redness, hypertrophy,

edema and glazing

bleeding on

probing/pressure

moderate

mar!ed redness,hypertrophy, edema,

ulceration

spontaneousbleeding

se"ere #

2he ingi$al *nde+ ,* was de$eloped y oe and 0ilness to

descrie the clinical se$erity of gingi$al inflammation as well

as its location.


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ingi$al *nde+ ,* oe ! 0illnessmenilai keparahan gingivitis

Papilla ,distofacial

Marginal ,facial

Papilla ,mesiofacial

Marginal ,lingual

( 045R*3 U3*2

,( P6RMU4AA3


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ingi$al *ndeks 7 8 skor tiap gigi

(

Arti hasil skor9

0kor : 9 normal

0kor % 9 peradangan ringan 7 sedikit peruahan warna; tdk

ada perdarahan saat palpasi

0kor & 9 peradangan sedang 7 kemerahan; uedem; erkilat;perdarahan pd palpasi

0kor ( 9 peradangan erat 7 kemerahan nyata; odem;

ulcerasi; cenderung

perdarahan spontan


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P6R*5#532A


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Perhitungan skor


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=g digunakan di klinik period.9

Papilla Bleeding Index (PBI)

*ndikator yang sensitif pd peradangan gingi$aUntuk menilai keerhasilan pengukuran/ kegagalan alat

dilangsungkan perawatan periodontalMencatat intensitas peradangan daerah papillaryMemoti$asi pasien ke arah keersihan mulut yg aikProe yg digunakan proe B


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Prosedur klinis P'*

dgn tekanan jari yg ringan dg proe period. tumpul dimasukkan dlm

sulcus

Proe ditegakkan dari dasar papil sampai ke ujungnya sepanjang aspek

mesial ! distal dr gigi

Menimulkan perdarahan

0eluruh kuadran diperiksa %: ) &: dtk

P'* 7 Dumlah 0kor perdarahan papil gingi$a

Dumlah 2otal papil yang diperiksa


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P6R*5#532A *3#6 ,P*

Russell de$eloped an inde+ for measuring periodontal

disease that could e used in population sur$eys. *t

can e ased solely upon the clinical e+amination; or

it can make use of dental -rays if they are a$ailale.

*t places greater emphasis on ad$anced disease.

0coring9

," 6ach tooth is scored separately according to the

following criteria.

,% Rule9 Bhen in dout; assign the lower score.


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$riteria for %ield &tudiesAdditional '()ay $riteria &core

negati"e *neither o"ert inflammation in the

in"esting tissues, nor loss of function due to

destruction of supporting tissues+

radiographic appearance normal 0

mild gingi"itis *o"ert area of inflammation in

the free gingi"ae, but this area does notcircumscribe the tooth+

1

gingi"itis *inflammation completelycircumscribes the tooth, but there is no

apparent brea! in the epithelial attachment+

*not used in field study+ early, notchli!e resorption of the al"eolarcrest

gingi"itis with poc!et formation *the epithelialattachment is bro!en, and there is a poc!et-

.here is no interference with normal

masticatory function, the tooth is firm in its

soc!et, and has not drifted-

horizontal bone loss in"ol"ing the entireal"eolar crest, up to half of the length of

the tooth root *distance from apex to

cemento(enamel unction+

ad"anced destruction with loss of masticatoryfunction *tooth may be loose tooth may ha"e

drifted tooth may sound dull on percussion

with a metallic instrument the tooth may bedepressible in its soc!et+

ad"anced bone loss, in"ol"ing more thanhalf of the length of the tooth root, or a

definite intrabony poc!et with definite

widening of the periodontal membranes-.here may be root resorption, or

rarefaction at the apex

2


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indi$idual score 7

7 AE6RA6 ,scores for all of the teeth in the mouth

population score 7

7 AE6RA6,indi$idual scores in population

e+amined

*nterpretation9

F minimum score9 :

F ma+imum score9 G

F 2he higher the score; the more marked the

periodontal disease.


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The Community Periodontal Index

of Treatment Needs (CPITN)

CPITN is an epidemiologic tool developed

by the World ealth !rgani"ation (W!)

for the evaluation of periodontal disease in

population surveys# It can be used to

recommend the $ind of treatment needed

to prevent periodontal disease#


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2eeth e+amined9 % methods of selection

,"se+tants% &' teeth on the maxilla and &' teeth on the

mandible divided into segments on each

*+I notation maxilla% ,"&, &- &. &'/ ,%& &0 && 0&00 0/ ,&0' 0. 0- 0,

*+I notation mandible% ,(', '- '. ''/ ,H' '0 '&& 0 / ,I' . - ,

third molars are not used unless they function in place ofthe second molars

(0) use of inde+ teeth% . teeth on the maxilla and . teeth on

the mandible

*+I notation maxilla% (&) &, &-/ (0) &&/ () 0- 0, *+I notation mandible% (') ', '-/ (.) &/ (-) - ,


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#ental e$aluation

,"A special proe is used to to e$aluate the depth ofthe dental sulcus.

,% 2he teeth are e+amined for supragingi$al or

sugingi$al calculus.

,& Any leeding after gentle proing is noted.


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Jinding 15#6

pathologic pockets >7 I mm deep :

pathologic pockets (-H mm deep "

supragingi$al or sugingi$alcalculus

%

gingi$al leeding after gentleproing

&

no signs of periodontal disease (

6$aluation

2he worst finding in each se+tant is coded according to

the tale elow.. 2he ma+imum code for the entire mouth is used for the

treatment recommendation.


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Treatment recommendation

ma+imum score :9 no need for additional treatment ma+imum score "9 need to impro$e personal oral

hygiene

ma+imum score %9 need for professional cleaning of

teeth; plus impro$ement in personal oral hygiene ma+imum score &9 need for professional cleaning ofteeth; plus impro$ement in personal oral hygiene

ma+imum score (9 need for more comple+ treatmentto remo$e infected tissue


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E!aluatin" teet#

5nly fully erupted ,occlusal and incisal surface has

reached the occlusal plane permanent teeth are scored.

2hird molars and incompletely erupted teeth are notscored ecause of the wide $ariations in heights of clinical

crowns.

2he uccal and lingual deris scores are oth taken onthe tooth in a segment ha$ing the greatest surface area

co$ered y deris.

2he uccal and lingual calculus scores are oth taken on

the tooth in a segment ha$ing the greatest surface areaco$ered y supragingi$al and sugingi$al calculus.


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3rading 4ebrisPoints

no debris or stain present 0

soft debris co"ering not more than one third of thetooth surface, A54/6) the presence of extrinsicstain without other debris regardless of surface areaco"ered

1

soft debris co"ering more than one third, but notmore than two thirds, of the exposed tooth surface

soft debris co"ering more than two thirds of theexposed tooth surface

#

de$ris index %

7 ,0UM,points along uccal surface for all segments present

0UM,points along lingual surface of all segments present / ,numer of

segments present


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3rading $alculusPoints

no calculus present 0

supragingi"al calculus co"ering not more than one third of the

exposed tooth surface

1

supragingi"al calculus co"ering more than one third but notmore than two thirds of the exposed tooth surface, A54/6)the presence of indi"idual flec!s of subgingi"al calculus aroundthe cer"ical portion of the tooth

supragingi"al calculus co"ering more than two thirds of theexposed tooth surface A54/6) a continuous hea"y band ofsubgingi"al calculus around the cer"ical portion of the tooth

#

calculus index =

1 (234(points along buccal surface for all segments present) 5234(points along lingual surface of all segments present)) 6 (number

of segments present)

oral hygiene index =1 (debris index) 5 (calculus index)


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Parameter(indin" S)ore

gingival score

negati"e 0

mild gingi"itis in"ol"ing the free gingi"a *margin,

papilla, or both+

1

moderate gingi"itis in"ol"ing both free and attachedgingi"a

se"ere gngi"itis with hypertrophy and easy hemorrhage #

bone score

no bone loss 0

incipient bone loss or notching of al"eolar crest 1bone loss about one fourth of root length, or poc!etformation one side not o"er one half of root length

bone loss about one half of root length, or poc!etformation one side not o"er three fourth root lengthmobility slight

#

bone loss about three 7uarters of root length, or poc!etformation one side to apex mobility moderate

bone loss complete mobility mar!ed 8

#


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gingial !one score1

7 0UM,,gingi$al score ,one score / ,numer of teeth e+amined

7 ,mean gingi$al score ,mean one score

In"er#re"a"ion

minimum score9 : ma+imum score9 G 2he higher the score; the more serious the

periodontal disease.


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The Sulcus Bleeding Index (SBI)

can e used to assess a patient for gingi$itis; which can e important in the

pre$ention of periodontal disease. 2his was initially called the LPM *nde+L;

ut the name was changed to pre$ent confusion with the LPMA *nde+L.

3umer of teeth e+amined9 "I ,the anterior ( in each ?uadrant; % on ma+illa

and % on mandile

2eeth in each ?uadrant

," medial incisor

,% lateral incisor,& cuspid

,( first premolar

0urfaces on each tooth proed9 (

," M laial

,% M lingual

,& P mesial

,( P distal

2otal numer of readings9 I(


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Periodontal Index of Russell

Russell de$eloped an inde+ for measuring periodontaldisease that could e used in population sur$eys. *t can

e ased solely upon the clinical e+amination; or it can

make use of dental -rays if they are a$ailale. *t places

greater emphasis on ad$anced disease.

Scoring:

," 6ach tooth is scored separately according to the

following criteria.

,% Rule9 Bhen in dout; assign the lower score.


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$riteria for %ield &tudiesAdditional '()ay $riteria &core

negati"e *neither o"ert inflammation in the

in"esting tissues, nor loss of function due to

destruction of supporting tissues+

radiographic appearance normal 0

mild gingi"itis *o"ert area of inflammation in the

free gingi"ae, but this area does not circumscribethe tooth+

1

gingi"itis *inflammation completely circumscribesthe tooth, but there is no apparent brea! in the

epithelial attachment+

*not used in field study+ early, notchli!e resorption of the al"eolar crest

gingi"itis with poc!et formation *the epithelial

attachment is bro!en, and there is a poc!et- .hereis no interference with normal masticatory

function, the tooth is firm in its soc!et, and has not

drifted-

horizontal bone loss in"ol"ing the entire al"eolar

crest, up to half of the length of the tooth root*distance from apex to cemento(enamel

unction+

ad"anced destruction with loss of masticatory

function *tooth may be loose tooth may ha"edrifted tooth may sound dull on percussion with a

metallic instrument the tooth may be depressible

in its soc!et+

ad"anced bone loss, in"ol"ing more than half of

the length of the tooth root, or a definiteintrabony poc!et with definite widening of the

periodontal membranes- .here may be root

resoprtion, or rarefaction at the apex

2


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individual score7

7 RA2A% ,scores for all of the teeth in the mouth

population score =

7 RA2A% ,indi$idual scores in population e+amined

Interpretation:

minimum score9 : ma+imum score9 G 2he higher the score; the more marked the periodontal disease

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EPID PERIOD.ppt