EPIDEMIOLOGY OF EPIDEMIOLOGY OF PERIODONTAL DISEASEPERIODONTAL DISEASE

ASPECT OF NORMAL GINGIVAASPECT OF NORMAL GINGIVA

CLINICAL NORMAL GINGIVACLINICAL NORMAL GINGIVA

HEAVILY PIGMENTED HEAVILY PIGMENTED GINGIVAGINGIVA

Supragingival calculus Supragingival calculus is depicted on the is depicted on the buccal surfaces of buccal surfaces of maxillary molars maxillary molars

adjacent to orifice for adjacent to orifice for Stenson’s duct Stenson’s duct

Extensive supragingival Extensive supragingival calculus on the lingual calculus on the lingual

surfaces of lower surfaces of lower anterior teeth anterior teeth

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

anterior teethanterior teeth

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

A lower incisor depicting a prominent A lower incisor depicting a prominent root without any attached gingiva root without any attached gingiva

and accompanying gingival and accompanying gingival recessionrecession

A patient following the placement of A patient following the placement of a soft tissue graft to gain attached a soft tissue graft to gain attached

gingiva and treat the gingival gingiva and treat the gingival recessionrecession

Overhanging margin of restoration Overhanging margin of restoration and atrophied and inflamed gingival and atrophied and inflamed gingival

papillapapilla

Marginal supragingival plaque and Marginal supragingival plaque and gingivitisgingivitis

Marginal gingivitis and irregular Marginal gingivitis and irregular gingival contourgingival contour . .

4848--hour plaque growth. Generalized hour plaque growth. Generalized gingivitis at the margins of almost all gingivitis at the margins of almost all

teethteeth

Generalized marginal inflammatory Generalized marginal inflammatory lesionlesion

Generalized diffuse inflammatory Generalized diffuse inflammatory lesionlesion

Papillary gingival enlargementPapillary gingival enlargement

Different degrees of recessionDifferent degrees of recession

Insertion of a probe into the gingival Insertion of a probe into the gingival sulcussulcus

Bleeding appears about 30 seconds Bleeding appears about 30 seconds after probingafter probing . .

Heavy calculus deposits Heavy calculus deposits on facial surfaces of on facial surfaces of upper first molar and upper first molar and

second premolarsecond premolar . .

Generalized gingival bleedingGeneralized gingival bleeding

Clinically normal gingiva- probe in Clinically normal gingiva- probe in placeplace

Clinically normal gingiva- profuse Clinically normal gingiva- profuse bleeding after 30 secondsbleeding after 30 seconds..

Generalized marginal gingivitisGeneralized marginal gingivitis

Localized diffuse gingivitisLocalized diffuse gingivitis

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

central incisorcentral incisor

Different types of periodontal Different types of periodontal pocketspockets

The epidemiology is the science of epidemics. The epidemiology is the science of epidemics. Epidemiological methods are utilized for Epidemiological methods are utilized for

determining what proportion of the determining what proportion of the population at a given time is affected by a population at a given time is affected by a

diseasedisease

The purpose of epidemiology is to increase The purpose of epidemiology is to increase understanding of the disease process to understanding of the disease process to identify the risk factors or deteminants of identify the risk factors or deteminants of

diseasedisease . .

One of the most valuable employed in dental One of the most valuable employed in dental epidemiology is the epidemiologic index epidemiology is the epidemiologic index

which help in defining diagnosiswhich help in defining diagnosis

A GOOD EPIDEMIOLOGY INDEXA GOOD EPIDEMIOLOGY INDEX: :

Must be easy to useMust be easy to use

Permit the examination of many people in a Permit the examination of many people in a short period of timeshort period of time

TYPES OF DENTAL INDICESTYPES OF DENTAL INDICES

11 / /Measures the number or proportion of Measures the number or proportion of people in a population with or without a people in a population with or without a

specific condition at a specific point in time specific condition at a specific point in time or interval of timeor interval of time

22 / /Merasures the number of people affected Merasures the number of people affected and severity of the specific condition at a and severity of the specific condition at a

specific time or interval of timespecific time or interval of time

INDICESINDICES

I. Plaque indicesI. Plaque indices

II. Gingival indicesII. Gingival indices

III. Periodontal indicesIII. Periodontal indices

IV. Treatment needs indicesIV. Treatment needs indices

Plaque indicesPlaque indices

Plaque index Plaque index Interdental hygiene indexInterdental hygiene index Hygiene indexHygiene index

Plaque indexPlaque index

This index concerns thickness of plaque along the gingival margin; this This index concerns thickness of plaque along the gingival margin; this plaque plays role in the etiology of gingivitisplaque plays role in the etiology of gingivitis

Grade Grade DescriptionDescription 0 0 No plaqueNo plaque 1 1 Thin film of plaque at the gingival Thin film of plaque at the gingival margin, visible margin, visible

Only when scraped with explorerOnly when scraped with explorer

2 Moderate amount of plaque along the gingival2 Moderate amount of plaque along the gingival margin;margin; Interdental space free of plaque;Interdental space free of plaque; Plaque visible with the naked eye.Plaque visible with the naked eye. 3 3 Heavy plaque accumulation at the gingival margin;Heavy plaque accumulation at the gingival margin; Interdental space filled with plaque Interdental space filled with plaque

Grade Description Grade Description 0 Normal gingival, no inflammation, no discoloration, 0 Normal gingival, no inflammation, no discoloration,

no bleedingno bleeding

1 Mild inflammation, slight color change, mild 1 Mild inflammation, slight color change, mild alteration of gingival surface alteration of gingival surface

No bleedingNo bleeding 2 2 Moderate inflammation, erythema, swelling, Moderate inflammation, erythema, swelling,

bleeding on probing, or whenbleeding on probing, or when Pressure appliedPressure applied

3 Severe inflammation, severe erythema and 3 Severe inflammation, severe erythema and swelling, tendency toward swelling, tendency toward

spontaneous spontaneous Hemorrhage, Hemorrhage, some ulceration some ulceration

Gingival IndexGingival Index

Papilla bleeding indexPapilla bleeding index

Grade DescriptionGrade Description1-point 1-point 20-30 seconds after probing the mesial and distal sulcus with a 20-30 seconds after probing the mesial and distal sulcus with a

periodontal probe, a single bleeding point is observedperiodontal probe, a single bleeding point is observed

2 -line/Points 2 -line/Points Thin film of plaque at the gingival margin, visible only when Thin film of plaque at the gingival margin, visible only when scraped with an explorerscraped with an explorer

3 -Triangle 3 -Triangle The interdental triangle becomes more or less filled with blood The interdental triangle becomes more or less filled with blood

4 - Drops4 - Drops Profuse bleeding. Immediately after probing, blood flows into Profuse bleeding. Immediately after probing, blood flows into the interdental area to cover portions of the the interdental area to cover portions of the

tooth or gingivatooth or gingiva

Periodontal Disease Index (PDI)Periodontal Disease Index (PDI) 0 0 No inflammation, no alterations in the gingivaNo inflammation, no alterations in the gingiva

GingivaGingiva

1 Mild to moderate gingivitis at some locations on the gingival margin1 Mild to moderate gingivitis at some locations on the gingival margin

2 Mild to moderate gingivitis of the entire gingival margin2 Mild to moderate gingivitis of the entire gingival margin

3 Advanced gingivitis with severe erythema, hemorrhage, ulceration 3 Advanced gingivitis with severe erythema, hemorrhage, ulceration PeriodontiumPeriodontium

4 Up to 3mm of attachment loss, measured from the cementoenamel 4 Up to 3mm of attachment loss, measured from the cementoenamel junctionjunction

5 3-6 mm of attachment loss5 3-6 mm of attachment loss

6 More than 6 mm of attachment loss 6 More than 6 mm of attachment loss

COMMUNITY PERIODONTAL INDEX OF COMMUNITY PERIODONTAL INDEX OF TREATMENT NEEDS (CPITN)TREATMENT NEEDS (CPITN)

Code CPI TNCode CPI TN 0 Healthy0 Healthy 1 Bleeding on probing I . Oral hygiene instruction1 Bleeding on probing I . Oral hygiene instruction 2 Supra and\or Subgingival2 Supra and\or Subgingival calculus II . I+ calculus removalcalculus II . I+ calculus removal Iatrogenic marginalIatrogenic marginal irritationirritation 3 Shallow pockets up to 3 Shallow pockets up to 5 mm III . I+II+ complex treatment5 mm III . I+II+ complex treatment 4 Deeper pockets from4 Deeper pockets from 6mm6mm

The Periodontal Screening and The Periodontal Screening and Recording ( PSR )Recording ( PSR )

The PSR examination was developed in The PSR examination was developed in order to streamline the data gathering and order to streamline the data gathering and

record keeping for the screening periodontal record keeping for the screening periodontal examinationexamination

The PSR exam is patterned after The PSR exam is patterned after the Community Periodontal the Community Periodontal Index of treatment needs Index of treatment needs

(CPITN ) of the world health (CPITN ) of the world health organizationorganization

This exam is completed with This exam is completed with periodontal probe that has a ball periodontal probe that has a ball at the tip and a black or colored at the tip and a black or colored

band from 3.5-5.5mmband from 3.5-5.5mmWhile six sites are examined per While six sites are examined per

toothtooth

The score for each sextant is The score for each sextant is determined and recordeddetermined and recorded

PSR CodesPSR Codes

Code 0 : The deepest probing in the sextant Code 0 : The deepest probing in the sextant is < 3.5mmis < 3.5mm

The colored band on the probe remains The colored band on the probe remains completely visiblecompletely visible

There is no bleeding, calculus, or defective There is no bleeding, calculus, or defective restorationsrestorations

The patient needs preventive care onlyThe patient needs preventive care only

•Code 1:The colored band on the Code 1:The colored band on the probe remains visibleprobe remains visible

There is no calculus or defective There is no calculus or defective restorative margins restorative margins

There is bleeding at the gingival There is bleeding at the gingival marginmargin

Plaque must be removed and the Plaque must be removed and the patient instructed in proper oral patient instructed in proper oral

hygienehygiene

Code 2: The colored band on the Code 2: The colored band on the probe remains completely visibleprobe remains completely visibleThere is detectable calculus and There is detectable calculus and or defective restorative marginsor defective restorative margins

Treatment consists of plaque and Treatment consists of plaque and calculus removal, Correction of calculus removal, Correction of

plaque retentive factors and oral plaque retentive factors and oral hygiene instructionhygiene instruction

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

the pocketthe pocket

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

at one siteat one site

Code *: An asterisk is added to Code *: An asterisk is added to the numerical sextant score the numerical sextant score when furcation involvement, when furcation involvement,

mobility, muccogingival problem mobility, muccogingival problem or recession is presentor recession is present