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PERIODONTICS > EPIDEMIOLOGY OF PERIODONTAL DISEASES > Flashcards

EPIDEMIOLOGY OF PERIODONTAL DISEASES Flashcards

1
Q

the study of the distribution of a disease or a physiologic condition in human population and of the factors that influence this distribution

A

epidemiology

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2
Q

3 Components of Epidemiology

A

population
distribution
factors

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3
Q

defined by
• geographic boundaries (racial)
• characteristics or attributes (age, old, or young group)

A

population

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4
Q

normal distribution

A

distribution

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5
Q

dependent and independent variables, confounders, exposure variables

A

factors

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6
Q

Aim of Epidemiology

A

Prevention of Disease (Control of disease)
Maintenance of health (promotion of health)

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7
Q

Basically organizing gathered information for it to be useful

A

maintenance of health

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8
Q

the dilemma in epidemiology

A

pendulum

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9
Q

Scope of Epidemiology

A

Part of it is research
• It can be used in every aspect of our lives

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10
Q

Uses of Epidemiology

A
  1. It can identify and measure the importance of health problems
  2. For understanding the natural history of disease
  3. It is essential for disease surveillance and control
  4. It contributes to the planning, monitoring and evaluation of health services (to know which disease to focus on)
  5. It serves as a key instrument in the formulation of health policies
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11
Q

Demographic Factors in the Prevalence of Periodontal Disease

A

age
sex
race
nutrition
socioeconomic status

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12
Q

Study Designs Used in Epidemiology

A

• Descriptive Studies
• Analytical Studies
• Observational studies
• Experimental Studies

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13
Q

Epidemiologic Researches are used in Periodontics

A
  1. Provide data on the prevalence of periodontal diseases in different populations
  2. Elucidates aspects related to the etiology and the determinants of development of these diseases.
    • determinants: risk or modifying
    • there are risk factors that can be modified (eg. lifestyle)
  3. Provide documentation concerning the effectiveness of preventive therapeutic measures against diseases
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14
Q

• Characterizes disease occurrence

A

descriptive studies

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15
Q

Provide clues regarding etiology

A

descriptive

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16
Q

Useful for formulating hypothesis

A

descriptive

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17
Q

Just describes the phenomena

A

descriptive

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18
Q

Tools: Case Studies (simplest form), Case Series (can hypothesize), Cross Sectional Studies

A

descriptive

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19
Q

Simply observes the natural course of events (no intervention, no control)

A

observational

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20
Q

Tools: Cross Sectional Studies, Cohort Studies (from exposure then look for the outcome), Case-Control Studies (reverse of cohort, for rare diseases, basic problem: case definition, denominator)

A

observational

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21
Q

May prove causal association and May lead to development of new hypothesis

A

experimental

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22
Q

Tools: Clinical Trials (expensive, only involves a small group of people) Community Trials (succeeds clinical trials if clinical is effective)
- involves the entire community
- factors: accessibility, cost, culture

A

experimental

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23
Q

Indices Used in Periodontal Disease Studies

A

• Periodontal Index by Russel (1956)
• Oral Hygiene Index (OHI) by Greene and Vermillion (1960)
• Plaque Index (PI) of Silness and Loe
• Interdental Hygiene Index (HYG)
• Hygiene Index (HI)
• Sulcus Bleeding Index (SBI)
• Gingival Index (GI)
• Gingival Index Simplified (GI-S, Lindhe 1981) and Gingival Bleeding Index (GBI, Alnamo, 1975)
• Papilla Bleeding Index (PBI)
• Ramfjord teeth
• Periodontal Disease Index (PDI)
• CPITN (Community Periodontal Index of Treatment Needs)

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24
Q

Focuses in gingivitis and also considers pocketing and mobility

A

periodontal index

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25
Q

describe the scores in periodontal index

A

Score 0
healthy
Score 1
gingivitis but not on whole gingival margin of tooth
Score 2
gingival inflammation along the cervical margin encircling the tooth
Score 6
periodontal pocketing, bone loss
Score 8
with excessive mobility

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26
Q

by Greene and Vermillion, 1960
• Concentrated on dental calculus because during that time, calculus is considered an etiologic factor for periodontal disease

A

oral hygiene index

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27
Q

scores in OHI

A

Score 0
no debris or calculus or plaque on tooth surface
Score 1
calculus extending 1/3 of the tooth
Score 2
calculus extending 2/3 of the tooth
Score 3
calculus on whole coronal portion of the tooth

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28
Q

by Silness and Loe

A

plaque index

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29
Q

The most important consideration is the thickness of plaque along the gingival margin, because only this plaque in direct contact with the gingival tissue plays any role in the etiology of gingivitis.

A

plaque index

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30
Q

Plaque is not stained, it is visualized by air drying
• Problem: subjective, what is moderate?
• relatively time consuming

A

PI

31
Q

scores in plaque index

A

Score 0
no plaque
Score 1
thin film of plaque at the gingival margin, visible only when scraped with an explorer
Score 2
moderate amount of plaque along the gingival margin; interdental space free of plaque; plaque visible with the naked eye
Score 3
heavy plaque accumulation at the gingival margin; interdental space filled with plaque

32
Q

It records plaque-free surfaces as a percentage

A

interdental hygiene index

33
Q

Usually scored with a quadrant from only one aspect. i.e.., from the facial or from the oral

A

interdental hygiene index

34
Q

It is a sensitive index because small plaque quantity is also measured and because the index is scored in the interdental areas, which are in most cases not particularly cleaned.

A

interdental hygiene index

35
Q

formula for interdental HI

A

HYG = Number of plaque free areas (-) x 100 number of examined areas

36
Q

not used in epidemiological studies because it is time consuming

A

interdental hygiene index

37
Q

• Recording plaque accumulation on all tooth surfaces

A

hygiene index

38
Q

this most precise index involves measurement of plaque accumulation on all four tooth surfaces (facial, oral, mesial, distal)

A

HI

39
Q

• A simple yes/no decision: dichotomous

A

HI

40
Q

Problem: loss of information because it can’t determine the degree of plaque accumulation which can tell who is more prone or susceptible

A

HI

41
Q

Was developed solely for use in individual patients

A

HI

42
Q

Muhlemann and Son, 1971
• Considers bleeding from the sulcus after probing, as well as erythema, swelling and edema

A

Sulcus Bleeding Index (SBI)

43
Q

Used as an indicator of gingival health, no bleeding (healthy)

A

Sulcus Bleeding Index (SBI)

44
Q

Has been used in various clinical studies but is also applicable to individual patients in a private practice setting

A

SBI

45
Q

Generally scored separately from both the papilla (P) and margin (M)

A

SBI

46
Q

grade in SBI

A

Grade 0
no bleeding on probing
Grade1
bleeding on probing, no changes in color or contour
Grade 2
bleeding on probing, eryhtema
Grade 3
bleeding on probing, erythema, mild edema
Grade 4
bleeding on probing, erythema, severe edema
Grade 5
bleeding on probing/spontaneous hemorrhage, severe edema with or without ulceration

47
Q

Silness and Loe, 1963
• Scores gingival inflammation on the facial, lingual, and medial surfaces of all teeth

A

gingival index

48
Q

The symptom of bleeding comprises a score of 2

A

GI

49
Q

Used worldwide in epidemiological studies and scientific investigations

A

GI

50
Q

Less applicable for individual patients because the differences between the scoring levels are too gross

A

GI

51
Q

GI scores

A

Grade 0
Normal gingiva, no inflammation, no discoloration, no bleeding
Grade 1
Mild inflammation, slight color change, mild alteration of gingival surface, no bleeding
Grade 2
Moderate inflammation, erythema, swelling, bleeding on probing or when pressure is applied
Grade 3
Severe inflammation, severe erythema and swelling, tendency toward spontaneous hemorrhage, some ulceration

52
Q

All four tooth surfaces are scored as (+) or (-) for bleeding on probing.

A

Gingival Index Simplified (GI-S, Lindhe 1981) and Gingival Bleeding Index (GBI, Ainamo, 1975)

53
Q

Negative observations are not entered into the chart.

A

Gingival Index Simplified (GI-S, Lindhe 1981) and Gingival Bleeding Index (GBI, Ainamo, 1975)

54
Q

Gingivitis incidence is calculated as a percentage of affected (bleeding) units.

A

GI-S,GBI

55
Q

Suited only for individual practice application on a routine basis.

A

GI-S,GBI

56
Q

by Saxer and Muhlemann, 1975
• permits both immediate evaluation of the patient’s gingival condition and his motivation, based upon the actual bleeding tendency of the gingival papillae.

A

papilla bleeding index

57
Q

PBI grades

A

Grade 1 - point
20-30 seconds after probing, the medial and distal sulcus with a periodontal probe, a single bleeding is observed
Grade 2 - linear/multiple pinpoint
A fine line of blood or several bleeding points become visible at the gingival margin
Grade 3 - Triangular bleeding
The interdental triangle becomes more or less filled with blood
Grade 4 - Drops/pooling
Profuse bleeding. Immediately after probing, blood flows into the interdental area to cover portions of the tooth or gingiva.

58
Q

For epidemiological purposes, six teeth could be taken as representative of the entire dentition (sextant)

A

Ramfjord teeth

59
Q

Use partial assessment
• Take the worst condition to represent the sextant
• Less time consuming

A

ramfjord teeth

60
Q

Contains a gingivitis index in scores 1, 2, and 3, and a measure of attachment loss independent of gingivitis, in scores 4, 5, and 6

A

periodontal disease index

61
Q

Designed for use in epidemiological studies, not for clinical practice

A

PDI

62
Q

Development using the Ramfjord teeth

A

PDI

63
Q

PDI SCORES

A

Score 0
No inflammation, no alterations in the gingiva
Gingiva
Score 1
Mild to moderate gingivitis at some locations on the gingival margin
Score 2
Mild to moderate gingivitis of the entire gingival margin surrounding the tooth
Score 3
Advanced gingivitis with severe erythema, hemmorage, ulceration
Periodontium
Score 4
Up to 3mm of attachment loss, measured from CEJ
Score 5
3-6mm of attachment loss
Score 6
More than 6mm of attachment loss

64
Q

Developed by Ainamo et.al. (1982) at the initiative of WHO

A

Community Periodontal Index of Treatment Needs (CPITN)

65
Q

Divide dentition into sextants with at least 2 teeth present on each sextant

A

CPITN

66
Q

Probing assessments are performed with the most severe measurement chosen to represent the sextant.

A

CPITN

67
Q

CPITN code for periodontal conditions

A

Code 0 - gingival health
Code 1 - no pockets, overhangs and calculus but with bleeding after probing
Code 2 - pockets not exceeding 3mm, but with plaque retaining factors seen located gingival
Code 3 - with 4 to 5mm deep pockets Code 4 - with pockets 6mm deep or greater

68
Q

Treatment needs are scores based on the most severe score in dentition

A

TN 0 - gingival health
TN 1 - need for improved oral hygiene (Code 1)
TN 2 - need for scaling and removal of overhangs and improved oral hygiene (Code 2 and 3)
TN 3 - indicating complex treatment (Code 4)

69
Q

designed to determine the treatment for a community

A

CPITN

70
Q

was used to determine prevalence

A

CPITN

71
Q

Disputed by Baelum

A

CPITN

72
Q

reasons of dispute by baelum

A
  1. calculus was the etiology
  2. Code 4 - surgery aided, treatment was constricted to specifics resulting to over treatment
  3. Use of index teeth - doesn’t represent all dentition.
    - overestimates for young people in
    prevalences
73
Q

pocket depth- not stable. measures soft tissue. Affected by: marginal inflammation, force applied, size of probe, etc.,
It is reversible
CEJ to attachment base - a more stable measure

A

CPITN

PERIODONTICS (4 decks)

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