1 Perioii 1 Epidemiology Week 1-2

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EPIDEMIOLOGY

Heidi Emmerling, RDH, PhD

DH 112 Periodontics ISpring 2008



H Emmerling, RDH, PhD

DHYG 112B Periodontics I

Spring 2008 2

Epidemiology� Key Terms:

± Epidemiology: The study of the

occurrence, distribution, and causes of

disease or disability

± Prevalence: Occurrence

± Extent: Distribution ± Severity: Given a numerical value with an

index





Spring 2008 3

Epidemiology� Prevalence of

gingivitis in the US:

± 50% of the overallpopulation

± 47% of employed

population

± 53% of seniors ± Males more than

females





Spring 2008 4

Epidemiology� Pattern of distribution of gingivitis in the

US

± Adults had 6 bleeding sites ± Seniors had 10 bleeding sites

� Severity of gingivitis in the US ± Have one or more bleeding sitesequivalent to a GI score of 2





Spring 2008 5

Epidemiology� Prevalence of

periodontitis in the US

± Attachment loss:

� 80% of employed males

� 73% of employed females

� 98% senior males

� 94% senior females

± Pocket Depth:

� 15% of adults aged 18-65

� 22% of seniors





Spring 2008 6

Epidemiology� Pattern of distribution of periodontitis

± Ranges from 5 pocketing sites in the average 18-

year-old subject to 15 sites in those aged 65 ± 10% of all surfaces had attachment loss at 18

± 50% of all surfaces had attachment loss at ages

60-64

± 15 % of all sites had pockets in seniors ± 60% of all surfaces have attachment loss by age

80





Spring 2008 7

Epidemiology� Severity of periodontitis

± Adult pocket was 4.25mm

± 2.04 mm attachment loss in employed

subjects

± Senior pocket was 5mm

± 3.5 mm attachment loss in senior men ± 2.99 mm of attachment loss in senior

women





Spring 2008 8





Spring 2008 9

IndicesPurpose: provide well-defined measuring

system to measure some specific

aspect of the disease or condition of

interest for large populations

The use of multiple indices permits the

association of various signs andsymptoms in the population





Spring 2008 10

Indices� Plaque and debris indices

± Plaque index of Silness and Loe (Pl I)

± Simplified Oral Hygiene Index (OHI-S) of

Greene and Vermillion





Spring 2008 11

Pl I

Silness and Loe Amount of plaque at margin

� 0 = no plaque

� 1 = no visible plaque but some on probe

� 2 = thin/mod layer visible to eye

� 3 = heavy; fills gingival crevice

� Tooth score: Add scores for measured

surfaces and divide by number of surfaces

� Mouth score: add tooth scores and divide by

number of teeth





Spring 2008 12





Spring 2008 13

Greene and Vermillion

OHI-S ± Has a DI-S (debris index) and a CI-S

(calculus index)

± DI-S is plaque portion� 6 teeth: #3B, #14B, #19L, #30L, #8Fa, #24Fa

� 0 = none

� 1 = < 1/3of tooth covered by debris or stain

� 2 = 1/3>2/3 of tooth covered by soft debris� 3 = > 2/3 of tooth covered by soft debris

� Add scores for all teeth and divide by number of teeth





Spring 2008 14

OHI-S





Spring 2008 15

Pl-I versus DI-S/OHI-S� DI-S of 2 means that

2/3 of the tooth is

covered by debris

� Pl-I of 2 means thin-

moderately thick

layer of plaque at

gingival margin





Spring 2008 16

Indices� Bleeding indices

± Gingival Index of Loe and Silness (GI)

± Sulcus Bleeding Index (SBI)





Spring 2008 17

The Gingival Index of Loe and

Silness (GI )Mesial, distal, lingual, and facial surfaces of the

tooth

± Use selected teeth or all teeth� 0 = absence of inflammation

� 1 = mild inflammation; slight color change, little change intexture, not bleeding

� 2 = moderate inflammation; red & swollen gingiva,bleeding on probing

� 3 = severe inflammation; significant redness &hypertrophy, spontaneous bleeding and ulceration

� Add scores and average the number





Spring 2008 18





Spring 2008 19

Sulcus Bleeding Index (SBI)

Mesial, distal, lingual, facial surfaces

Check for bleeding 30 seconds after withdrawingprobe

± 0 = healthy appearance and no bleeding ± 1 = no color or contour change but bleeding on

probing

± 2 = bleeding, color change, no swelling

± 3 = bleeding, color change, slight swelling

± 4 = bleeding, obvious swelling, with or withoutcolor change

± 5 = spontaneous bleeding, color change,significant swelling with or without ulceration





Spring 2008 20

Indices� Periodontal Indices

± Russell¶s Periodontal Index (PI)

± Periodontal Disease Index of Ramfjord

(PDI)





Spring 2008 21

Russell¶s PI

± Weighed more towards bone loss than gingival

inflammation

± Developed in 1950s and provided importantinformation that was not previously quantified





Spring 2008 22

PI (Cont)

Scores are added and averaged

± 0 = no inflammation or loss of function

± 1 = mild gingivitis, inflammation of free gingiva butnot circumscribing the tooth

± 2 = gingivitis with inflammation circumscribing thetooth but normal pocket depths

± 6 = gingivitis with pocket formation, sulcus is

deepened, normal function, no drifting ± 8 = advanced destruction with loss of masticatory

function, tooth may be loose, sound dull onpercussion and depressible in pocket





Spring 2008 23

Ramfjord¶s PDI ± Measures gingivitis and periodontitis

± Evaluates #3, #9, #12, #19, #25, #28 as

representative of the entire dentition

± Scores are added and averaged





Spring 2008 24

PDI (Cont)

± Gingivitis

� 0 = negative

� 1 = mild gingivitis (free gingiva)� 2 = moderate gingivitis free and attached

gingiva)

� 3 = severe gingivitis with hypertrophy and

hemorrhage





Spring 2008 25

PDI (Cont)

± Periodontal disease (gingivitis score is

disregarded)

� 4 = pocket depths on 2 or more surfacesextending as much as 3mm apical to the CEJ

� 5 = pocket depths on 2 or more surfaces

extending 3-6mm apical to the CEJ

� 6 = pocket depths on 2 or more surfacesextending more than 6 mm apical to the CEJ





Spring 2008 26

Indices� Calculus Indices

± Calculus index of the OHI-S/ Greene and

Vermillion

± Volpe Manhold probe method of calculus

assessment (VM)





Spring 2008 27

Calculus indices� OHI-S

± DI-S portion of OHI-S

� 6 teeth: #3B, #14B, #19L, #30L, #8Fa, #24Fa

� 0 = no plaque

� 1 = <1/3 tooth covered by plaque

� 2 = 1/3> 2/3 tooth covered by plaque

� 3 = > 2/3 tooth covered plaque

� Add scores for all teeth and divide by number

of teeth





Spring 2008 28

OHI-S=DI+CI ± CI-S portion of OHI-S

� 6 teeth: #3B, #14B, #19L, #30L, #8Fa, #24Fa

� 0 = no calc� 1 = <1/3 tooth covered by calc

� 2 = 1/3> 2/3 tooth covered by calc w/some sub

� 3 = > 2/3 tooth covered sub and ring of sub

� Add scores for all teeth and divide by number of teeth





Spring 2008 29





Spring 2008 30





Spring 2008 31

Calculus indices� VM

± Only supragingival calculus

± Designed to measure lingual of mandibular anteriors but can work on any tooth

± Use a probe to bisect each of three parts of the lingual aspect and measure the height

of calculus ± Measure the mesial, lingual, and distal and

average to get the tooth score





Spring 2008 32





Spring 2008 33

Dental Hygiene Role� Lots of periodontal disease in the US

� Bleeding, gingivitis, calculus, pockets





Spring 2008 34

Dental Hygiene Role� Data suggests that much of the periodontal

treatment needed by most individuals can be

provided by dental hygienists� Collaboration with dentists and periodontists,

proper assessment of individual needs,

calculus and plaque removal, and prevention

education are required to providecomprehensive dental hygiene care





Spring 2008 35

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1 Perioii 1 Epidemiology Week 1-2