Epi of Perio Flashcards
Epidemiology is about who
the population-NOT the individual
Groups of diseases in periodontal disease
Gingivitis – reversible, inflammation of the gingiva, the junctional epithelium remains attached to the tooth at the original level
Periodontitis – chronic, inflammation of the gingiva and surrounding bone that supports the tooth, loss of support can lead to tooth loss
Do not know numbers!!
-If there is a number it is WRONG!
(:
Why forecast disease occurrence?
To prevent disease!
What to study/focus on in epidiemology (4 things)
Do not worry about this much, just some extra knowledge
Epidemiology
Distribution
Risk factors
Preventative strategies at the population level
Link between periodontal and systemic disease
Periodontal disease (define key terms)
a generic term to describe a group
of inflammatory conditions affecting tooth-supporting tissues
Is periodontal disease reversible?
Gingivitis is!!!!! Periodontitis is NOT!
Periodontitis prevalence based on gender
Men»_space;> women
How do we capture Perio disease on a global level?
-Describe the national health surveys
Less than 10 national oral health surveys include periodontal assessment, only five use similar measurements
Gingivitis and calculus deposits are ______ and
_____ in low-income nations
More prevalent and more severe
% of adult population with periodontitis
50%
% of population with severe periodontitis (is it common?)
5-15%, so kind of yeah, but a small proportion globally have severe periodontitis **KNOW THIS
What is a cause of mixed results about the prevalence of gingavitis
Mix results about the prevalence of gingivitis due to lack of agreement on measurement criteria
How many adults have gingivitis? Adolescents?
over half adults- adolescents even more (~80%)
With age, prevalence of periodontitis does what
increases, more towards 15% of the 5-15
Ethnicity with highest prevalence of Periodontitis
Mexican-Americans
Perio and education level
lower education = higher rates
Risk Factors -Modifiable (6)
Modifiable • Smoking, Nutrition • Dental plaque, Oral hygiene • Psychological factors • Obesity • Socioeconomics • Specific microorganisms
Risk Factors- Non-modifiable (4)
Non-Modifiable • Genetic • Aging • Gender • Ethnicity/Race
Factors related to why high SES have better gingival
health (3)
Improved oral hygiene, regular dental visits, having
dental insurance
Strength of evidence linking genetics and periodontal health
WEAK evidence
Measurements of Perio Disease (5)
• Pocket depth (PD)- current periodontal disease • Clinical attachment loss (CAL)-past periodontal disease • Bleeding on probing (BP) • Self-reported measure • Bone loss: alveolar crest to CEJ
* considered best indicators to measure periodontal
health of the population
- considered best indicators to measure periodontal
health of the population
• Bone loss: alveolar crest to CEJ
Self reported indicators of Perio Disease (6)
- Malodor/bad taste
- Oral hygiene aid use
- Pain/discomfort
- Previous diagnosis of periodontal disease
- History of periodontal treatment
- Self rating of gingival health
**Just be aware of these
Assessment Concern for Periodontal Disease Measurement
hint one reason with 3 things under that reason
Lack of uniformity and constant change:
• in the criteria for disease identification in the
population
• in the threshold used for assessment in studies
• in the sites assessed for the disease in different
studies
Concerns of the Perio Probe (8)
- Diameter of probe
- the tine
- Force Applied
- Angulation of the probe tine to the wall
- Experience of examiner
- Prevelence of overhang
- Accuracy on tine
- Probe penetration
Perio Disease Indices are used to measure the following (4)
- Plaque or soft deposits on teeth
- Calculus
- Gingival inflammation
- Periodontal destruction/ loss of attachment
Grades of Plaque index (0,1,2,3)
DO NOT HAVE TO KNOW EACH ONE
0: Plaque free, no plaque collection
1: Thin film of plaque at the gingival margin, visible and easily scraped with explorer
2: Moderate amount of plaque along gingival margin; interdental space free of plaque; plaque visible with the naked eye
3: Heavy Plaque accumulation at the gingival margin; interdental space filled with plaque
Gingival Index 0-3
DO NOT HAVE TO KNOW EACH ONE
Normal gingival, no inflammation, no discoloration, no bleeding probing
Mild inflammation, slight color change, mild alteration of gingival surface, no bleeding on probing
Moderate inflammation, erythema swelling, bleeding on probing or with application of pressure
Severe inflammation, severe erythema and swelling, tendency towards spontaneous hemorrhage, some ulceration
Plaque index
• Good reproducibility • Original designed to be used in six teeth, but other
combinations are now used • Original teeth:
u maxilla: Right lateral incisor, 2nd molar and left 1st
premolar u Mandible: Right 1st premolar, left lateral incisor,
2nd molar
Perio index used
CPIT-N
Community periodontal index of treatment needs
Ainamo et al 1982
0 in an index
Normal
Community Periodontal Index of Treatment Needs (CPITN) determines what? Used in what?
Easy or hard on a global scale?
Joint with who?
- Joint working committee of the WHO and FDI
- Determines severity of gingivitis and periodontitis
- Primarily used in epidemiological studies
- Easy to use and has global acceptance
Limitations of CPTIN-(3)
THIS IS A QUESTION
• Index based on a hierarchical concept of the progression of periodontitis. Such that a tooth with a
score of 3 or 4 (pocket) should have calculus (score 2) and bleeding (score 1) —does not allow us to talk about ATTACHMENT LOSS
• It does not measure tooth mobility or attachment loss or
furcation involvement
• Concern about examining the periodontium of a few
teeth as representative of the periodontal health or
disease of the whole teeth in the mouth
Community Periodontal Index of Treatment evaluates what
perio treatment needs of population
Main Limitation of CPTIN
You cannot use CPTIN to evaluate individuals-ONLY Populations!
CPI does what (2 modifications to CPITN)
Includes clinical loss of attachment (sometime
optional)
Eliminates treatment need
An index for Perio screening?
Yes, Perio Screening and recording, THERE IS AN INDICE
INDICES for what (3 or so)
Plaque, Calc, Perio, Community perio index
Epidemiology is a(n) _______ important
for “hypothesis generation” than demonstration of
proof
an observational science
Epidemiology is an observational science important
for “__________” than demonstration of
proof
hypothesis generation-asking more questions
Epidemiological studies are important to help improve 2 things
• improve our understanding of risk factors of
periodontal disease, prognosis and long-term
outcomes of care
• Improve our understanding of periodontal -
systemic associations
Rigorous training and calibration of examiners are important in epidemiology of periodontal disease
especially when data is intended for public health planning
just a fact, not on perio exam
…
In cases where partial mouth assessments are done a
________ should be calculated to account for
possible differences between _____ and ______
assessment
- -correction factor
- -between partial and full mouth assessment
In cases where partial mouth assessments are done a
correction factor should be calculated to account for
possible differences between partial and full mouth
assessment
KNOW This and it is from NHANES!!!!
We used to use what and now use what
partial mouth now we use full mouth assessment, this is on the exam!
Complete mouth assessment is not important, true or false???
FALSE
