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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


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


adults


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


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


PERCENTAGE OF SUBJECTS WITH HEALTHY PERIODONTIUMPERCENTAGE OF SUBJECTS WITH HEALTHY PERIODONTIUM


EAST GERMANY 1985EAST GERMANY 1986EAST GERMANY 1987

EAST GERMANYESTONIA 1987


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 )


FINLAND 1988FRANCE 1987FRANCE 1988FRANCE 1989


GREECE 1985IRELAND 1989

ITALY 1985NETHERLANDS 1983NETHERLANDS 1986

NORWAY 1983PORTUGAL 1984

SPAIN 1993U.K. 1985

0 5 10 15 20 25

DESTRUCTIVE



PERCENTAGE OF SUBJECTS HAVING AT LEAST ONE SEXTANT WITH DESTRUCTIVE PERIODONTAL DISEASEPERCENTAGE OF SUBJECTS HAVING AT LEAST ONE SEXTANT WITH DESTRUCTIVE PERIODONTAL DISEASE


EAST GERMANY 1985EAST GERMANY 1986EAST GERMANY 1987

EAST GERMANYESTONIA 1987


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


32321313212185/9185/9122HungaryHungary

51511818323286/9086/9033PolandPoland




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


1515114485/9185/9122HungaryHungary

343477161686/9086/9033PolandPoland




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


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


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


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.


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


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.


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



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.





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


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


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 (%)


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




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




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


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




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




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


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


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




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


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.

-

+

+

+




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.


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) .





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




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




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


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









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


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


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

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