Dental health and dental treatment needs among recruits of the Finnish Defence Forces, 1919-91.

The first two surveys of the dental health of young Finnish men were conducted in 1919 and 1965. The objective of four subsequent surveys (1976, 1981, 1986, and 1991) was to collect both interview and clinical examination data for the monitoring of changes in the oral health status of the recruits. A significant reduction in self-reported toothache, gingival bleeding, and number of decayed teeth was observed from 1976 to 1991. At examination, the numbers of decayed teeth, teeth indicated for extraction, teeth in need of fillings, and missing teeth decreased substantially, as did the teeth with visible plaque, subgingival calculus, and teeth with 4-mm or deeper periodontal pockets. This comprehensive series of successive cross-sectional oral health surveys clearly shows that since 1976 a significant decrease in oral disease and treatment needs has taken place among the Finnish population of young men.

Assessment of the effect of an oscillating/rotating electric toothbrush on oral health. A 12-month longitudinal study.

The aim of this 12-month parallel design controlled clinical trial was to assess the effect of the Braun Oral-B Plak Control electric toothbrush on supragingival plaque and gingival health, and to compare it with a conventional soft manual toothbrush (Jordan). A total of 111 patients aged between 20 and 63 years, from a general population, with bleeding on probing at 30% or more of all sites examined were entered into the study. At baseline, immediately after periodontal examination, all volunteers received a thorough scaling of their teeth. Volunteers in both groups were told to brush their teeth for 2 min 2 x a day. Oral hygiene instruction was given at the start of the study and was not repeated. At 3, 6 and 12 months, assessments were carried out by a single clinician who was not aware which group the volunteers belonged to. Analysis of results demonstrated that over the 12 months of the study, the Braun Oral-B Plak Control was significantly more effective in improving gingival health than the manual toothbrush. There was, however, no difference between the 2 groups in terms of plaque removal, with the number of sites with visible plaque decreasing by a similar amount in both groups. In conclusion, results indicate that the Braun Oral-B Plak Control toothbrush is safe and more effective than a manual toothbrush in improving gingival health.

Risk assessment of recurrence of disease during supportive periodontal care. Epidemiological considerations.

Although it is accepted that the primary cause of periodontitis is bacterial infection of long duration, there are a number of risk factors which may increase the probability of recurrence of periodontal disease during supportive periodontal care. The risk may in such cases be caused by other factors than poor oral hygiene measures per se. Cross-sectional and longitudinal studies show conflicting results concerning age as a risk factor for periodontal disease. The effect of smoking on the periodontal tissues has been discussed for decades and only lately has it been possible to demonstrate that smokers definitely have more periodontal problems than non-smokers. Another important risk factor for periodontitis relates to the insulin dependent and non-insulin dependent forms of diabetes mellitus. Poorly-controlled long-duration diabetics have more periodontitis and tooth loss than well-controlled or non-diabetics. Finally, the issue of compliance deserves attention. The medical literature has suggested that patients with chronic illnesses tend to comply poorly, especially if the disease is not perceived to be particularly threatening, if the therapy is time-consuming, or if the symptoms are non-disturbing. Suggestions for improved compliance are called for.

Improved periodontal status through self-assessment. A 2-year longitudinal study in teenagers.

Short-term success of the use of self-assessment for motivating adults to improve their oral health status has been reported. The purpose of this trial was to evaluate the long-term effectiveness of two self-assessment strategies, one focused on gingival bleeding (group I) and another focused on plaque (group II). At baseline, 493 14- and 15-year-olds were assigned randomly to a group. Each subject was given a manual describing one of the self-assessment processes. Dental hygienists provided standardized classroom based instruction and two weeks later, individualized counselling. Examinations were conducted at baseline 6, 12, 18 and 24 months for gingival bleeding on probing, plaque, calculus, and probing depth; and at baseline and 24 months for recession and decayed, missing and filled surfaces (DMFS). Following the 12-month examination, subjects received an oral prophylaxis and individual counselling. The results revealed no statistically significant differences between groups for any clinical parameter at the final examination. However, the mean number of sites with gingival bleeding decreased steadily from baseline to 24 months with a 59% decrease and 55% decrease for groups I and II, respectively. This study suggests that self-assessment approaches can be effective in improving the long-term periodontal health status of teenagers.

Self-reported gingivitis and bleeding gums among adolescents in Helsinki.

The purpose of this descriptive cross-sectional community based investigation was to analyze the relationship between professionally measured and perceived gingival health in a sample of 1217 adolescents (age 14.0 +/- 0.7 yr). The responses to two questionnaire items relating to self-reporting of "gingivitis" ("inflammation of gums" in Finnish) and "bleeding from gums" are reported along with Community Periodontal Index of Treatment Needs (CPITN), percentage of bleeding sites (BOP%) and modified Papillary Bleeding Index (PBI) scores. It was found that current or past "gingivitis" was less often reported than "bleeding from gums" by this sample and that responses to both items exhibited low levels of agreement with the clinical measures. The results suggest that the self-reporting of gingival health may be useful in monitoring the gingival health of populations but does not have sufficient validity for screening individuals for gingivitis as defined by dental professionals. Furthermore, it is suggested that the term "bleeding from gums" rather than "gingivitis" should be used during clinical or group oral health promotion.

Validity and relevance of the criteria of the CPITN.

The validity and relevance of the criteria used in the CPITN index are considered against the background of their use throughout the world in the last 15 years. Overall the CPITN criteria satisfy both measures, although some suggestions are given for further refinements. It is recommended that, in conjunction with the Periodontal Screening and Recording system, a simplification to five code numbers for both findings and treatment needs be considered. Other matters considered should include the discontinuation of the description 'shallow pocket', training in the use of a 20 g probing force and a lowering of the age at which periodontal screenings are commenced for children.

Self-assessment of gingival bleeding.

The benefit obtained from the use of a manual for self-assessment of gingival bleeding was evaluated among a group of Finnish army conscripts. After the baseline examination, performed by a dentist, three test groups self-assessed bleeding from their gums during toothbrushing and when cleaning between their teeth with a toothpick. The dentist re-examined the first test group 1 month, the second group 3 months and the third group 6 months after the self-assessment. Gingival bleeding among the test group subjects was compared with that of control group subjects who had been matched for number of bleeding sites at baseline. The self-assessed gingival bleeding was found to correlate with the clinical findings of bleeding. One and 3 months after the self-assessment the test groups had better gingival health than their respective control groups. Six months after the self-assessment, no difference in gingival health was found between the test and control groups. Observed gingival bleeding during the original self-assessment was found to be a positive predictive factor for the subsequent improvement in gingival health.

[Periodontal treatment needs in a Spanish school population]. / Necesidad de tratamiento periodontal de la población escolar Espanõla.

The aim of this study was to assess the periodontal treatment needs of the population under 20 years of age in Spain. 1469 young people, aged 7, 12 and 15-19 years, and representing the urban (60%) and rural (40%) population from Spain were evaluated using the Community Periodontal Index of Treatment Needs (C.P.I.T.N.). In the first age group (7 years), 12% presented calculus or overhanging restorations, and 45% had bleeding upon probing only. In the age group of 12 years the proportion of individuals with calculus, overthanging restorations or moderate pocket depths was 39%, while 38% had gingivitis as their highest treatment need. In the oldest group (15-19 years) the number of subjects with bleeding upon probing decreased to 17%, while the percentage of individuals having moderate pockets, calculus or overhanging restorations increased to 67%. 1% of this youngsters had pockets of 6 mm. or over. At age 7, only 30% had "acceptable gingival health", and no more than 15% of the 18 year-olds reached this condition.

[Periodontal treatment needs in a Spanish school population. 2. Intraoral distribution of different signs]. / Necesidad de tratamiento periodontal de la población escolar Española. II. Distribución intrabucal de los diferentes signos.

The aim of this study was to assess the prevalence of the different periodontal disease indicators used in the C.P.I.T.N. per sextant in the Spaniard population under 20 years of age. We have examined a randomly chosen sample of 1450 school-aged individuals, 7, 12 and 15 to 19 years old. We have observed a healthy periodontium more frequently in the upper anterior region, calculus predominates in the lower incisors close followed by molars, and periodontal pockets of 4 mm or deeper were commonly found in the molar regions. We could'nt detect important deviations from this distribution pattern in the different age groups or between males and females.

[Caries prevalence and periodontal treatment needs in the same individuals]. / Prevalencia de caries y necesidad de tratamiento periodontal en los mismos individuos.

The aim of this study was to determine whether dental caries and periodontal disease occur frequently in the same subjects 1469 young people, aged 7, 12 and 15-19 years, and representing the urban (60%) and rural (40%) population from Spain were evaluated. Dental caries and periodontal treatment needs were registered according to the index D.M.F.T. and C.P.I.T.N., following the criteria of WHO. We have found a highly significant relation between both variables, average D.M.F.T. scores increased as periodontal treatment needs were more advanced. Those subjects with lower codes of C.P.I.T.N. presented also lower D.M.F.T. scores, while these individuals with higher D.M.F.T. scores, based on a great number of open carious lesions, were more affected for periodontal disease. It does not support either a directly synergistic or antagonistic correlation in the prevalence of these two diseases in the same subjects. Dental health status is at a certain time an end result of years of varying dental health behaviour. In industrialized countries a variety of factors seems to determine the prevalence of dental caries and/or periodontal disease: dietary habits, access to fluorides, efficacy of oral hygiene measures, utilization of dental health care services. These data and ideas supported the strategy of preventing the dental caries and periodontal disease simultaneously.

[Relationship of dental treatment and oral hygiene to caries prevalence and need for periodontal treatment]. / Relación entre el tratamiento dental y la higiene oral con la prevalencia de caries y necesidad de tratamiento periodontal.

The aim of this study was to examine the relationship between differences in dental attendance and oral hygiene patterns and dental caries and periodontal treatment needs. 1469 young people, aged 7, 12 and 15-19 years, and representing the urban (60%) and rural (40%) population from Spain were evaluated. Dental caries and periodontal treatment needs were registered according to the index D.M.F.T. and C.P.I.T.N., following the criteria of W.H.O. Regular dental attendance was observed in 16.6% of subjects examined, and only 9.4 saw a dentist regularly for dental prophylaxis. Statistical analyses showed that while the more frequent the dental visits, the lower the rate of caries, and periodontal treatment needs, the higher, however, the average number of fillings and the D.M.F.T. scores. These individuals had the higher number of functioning teeth, restored or sound, but they also had the disadvantage of having higher levels of disease experience. By the other way the individuals who saw the dentist regularly for dental prophylaxis presented the lower caries rate and periodontal treatment needs, the fewer tooth loss, and also an important reduction in the D.M.F.T. scores. Similar observations had been made in the individuals who brush their teeth frequently or with a correct technique. The results suggested that while frequent dental visits do not apparently help to prevent the onset of further dental disease, we can achieve this goal with regular preventive oriented dental therapy.

[Early diagnosis of periodontal disease]. / Diagnostico precoz de la enfermedad periodontal.

Early diagnosis is necessary if the prevalence of periodontal disease is to be brought under control. For periodontal screening in dental practice we propose to employ the C.P.I.T.N. system, combined with examination of two or four dental bite-wing radiographs. Both of these procedures can be accurately applied in general dental practice conditions. The screening is not time consuming and can yield very important diagnostic data.

Time estimates for dental treatment in four age cohorts of an adult population.

Needs for tooth extractions, conservative dental treatment--including periodontal and caries treatment--and occlusal rehabilitation--including stomatognathic and prosthetic treatment or a combination of these--in a Finnish adult population were summarized and time estimates for the treatment calculated. The study population consisted of 1,275 adults in four age cohorts--25, 35, 50, and 65 years. A decrease was observed from five hours of total dental treatment time needed at ages 25 and 35 years to four hours at age 50 years and three hours at 65 years. At the age of 25 years, 86 percent of the treatment time (255 min) was needed for conservative therapy, the corresponding figures at 65 years being 35 percent (66 min). On the other hand, a fivefold increase (from 13% to 62%) in the proportion of time needed for occlusal rehabilitation was observed between age 25 and 65. A combination of stomatognathic and prosthetic treatment was most frequently needed. The percent of time needed for tooth extractions varied from 1 to 3 percent among the four age cohorts.

The community periodontal index of treatment needs (CPITN) procedure for population groups and individuals.

The FDI-WHO Joint Working Group 1 on periodontal diseases supports the use of the CPITN as an epidemiological screening procedure for periodontal treatment needs in populations and also, in a modified form for screening and monitoring of individuals by dental practitioners. The advantages of the CPITN procedure have become more evident following 7 years of development and field experience. This report reviews the CPITN procedure and describes in detail the use of the method for both purposes. Methods, clinical criteria and evaluation of the CPITN data are discussed. The CPITN is primarily a screening procedure which requires clinical assessment for the presence or absence of periodontal pockets, calculus and gingival bleeding. Use of a special CPITN periodontal probe (or its equivalent) is recommended. For epidemiological purposes in adult populations, 10 specified index teeth are examined; for persons under 20 years of age only six index teeth are specified. In dental practice all teeth are examined and the highest score for each sextant noted. Only 6 scores are recorded. Measures of gingival recession, tooth mobility, intensity of inflammation, precise identification of pocket depths or differentiation between supra- and subgingival calculus are not included in the CPITN. Individuals are assigned to one of four treatment need categories determined from their CPITN scores. Detailed explanations are given for the evaluation of epidemiological data. Four tabulations provide an insight into the overall pattern of prevalence, severity and categories of treatment need. For health services planning, the data provide a basis for estimating overall population needs in terms of treatment categories and the clinical personnel required for periodontal care. In the clinical care situation the procedure offers a simple screening method for determining the level of intervention required and also a tool for the longitudinal monitoring of disease changes. Used with commonsense and an understanding of periodontal disease, the CPITN procedure provides the epidemiologist and the practitioner with a practical means of assessing periodontal treatment needs.

Use of CPITN cross-tabulations--a research perspective.

In earlier years, studies on the epidemiology of periodontal disease were often reported in the form of mean scores for the population studied. Use of the WHO recommended Community Periodontal Index of Treatment Needs (CPITN) has given important additional information, particularly about the distribution of indicators of current periodontal disease within various age groups of the population. In the analysis of survey data, the use of CPITN cross-tabulations has been found particularly promising for the assessment of both preventive and therapeutic needs. For example, in Finnish schoolchildren the proportion of subjects with two or more sextants scoring Code 2 for calculus increased from 0 per cent at age 7 to 5 per cent at age 12 and 9 per cent at age 17 years. In the same population, 0 per cent at 7, 1 per cent at 12, and 4 per cent at 17 years of age had one or more pockets measuring more than 3 mm. In another population, comprising dentate adults from rural Finland, the prevalence of Code 4 for 6 mm or deeper pockets increased from 1 per cent at age 25 to 6 per cent at age 35, 18 per cent at age 50, and 27 per cent at 65 years of age. An important additional observation was that a total of 58 per cent of those who had one or more Code 4's, had their advanced periodontal disease confined to only one sextant. The latter finding may prove useful when deciding between partial and full mouth examinations in future epidemiological studies.