Epidemiology of Gingival and

Periodontal Diseases
WHAT IS EPIDEMIOLOGY?

Epidemiologic Measures of Disease.

Aims of Epidemiology

Three main aims have been proposed:

a-To describe the distribution and size of disease problems in human populations.

b-To identify the etiological factors in the pathogenesis of disease.

C-To provide the data essential for the planning, implementation and evaluation of services for the prevention.
control and treatment of disease

Prevalence

. Epidemiology is "the study of the distribution and determinants of health-related states or events in
specified populations, and the application of this study to control health problems."“

Epidemiology traditionally has been considered a basic science of public health.

What distinguishes public health practice from clinical practice is that public health practice
emphasizes the health of population groups, whereas clinical practice is concerned with the health of
individual patients.

Epidemiologic Measures of Disease

Prevalence

Prevalence is the proportion of persons in a population who have the disease of interest at a given
point or period of time . It is calculated

by dividing the number of persons in the population who have the disease by the number of persons
in the population

Prevalence, which can be reported as a proportion or percentage, is a measure of the burden of

disease in a population.

Information about prevalence can be useful for estimating the need for health care resources.

For example, prevalence data on dental disease is used for estimating the number of new general
dentists and specialists that dental schools should train. Several factors influence the prevalence of
disease.

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The prevalence of a disease at a given point in time is the result of the dynamic situation between the
addition of new cases (incidence), which increases prevalence, and the removal of cases through
death or cure, which decreases prevalence

Incidence

Incidence-also referred to as risk or cumulative incidence is the average percentage of unaffected

persons who will develop the disease of interest during a given period of time.

Incidence can be viewed as the risk or probability that a person will become a case.

It is calculated by dividing the number of new cases of disease by the number of persons in the
population who are at risk for the disease.

Whereas prevalence is a measure of the amount of disease existing in a population, incidence is a

measure of the occurrence of new disease.

The numerator of the incidence equation is the number of persons who transition from a nondiseased
state to a diseased state during the period of observation.

The denominator in the equation must contain only those persons in the population who are at risk
for but do not have the disease at the start of observation.

For example, in a study of oral cancer, only individuals who are free of oral cancer at the beginning of
the study could be included in the population at risk.

In the expression of incidence, specifying the period.

Whereas prevalence is a measure of the amount of disease existing in a population, incidence is a

measure of the occurrence of new disease.

The numerator of the incidence equation is the number of persons who transition from a non
diseased state to a diseased state during the period of observation.

Epidemiologic Study Designs

To investigate the prevalence and incidence of disease, risk factors associated with disease, and the
effectiveness and efficacy of interventions, researchers conduct epidemiologic studies.

Most epidemiologic studies are observational.

In these studies, the researchers observe natural occurrences in the population.

The most common observation studies are cross-sectional, cohort, and casecontrol studies.

In addition to observational studies, epidemiologists also conduct experimental studies in which they
manipulate exposures, such as in drug trials when one group of subjects receives the study drug and
another group receives a placebo.

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Sensitivity and Specificity

When a diagnostic test for a disease or condition gives a positive result, the result can be correct (true
positive) or incorrect (false positive).

When a test gives a negative result, the result can be true (true negative) or false (false negative) .

The ability of a test to give a correct answer is indicated by its sensitivity and specificity.

The sensitivity of a test is the proportion of subjects with the disease who test positive.

INDEX

These are numerical values describing the relative status of the population on a graduated scale with
definite upper and lower limits, which are designed to permit and facilitate comparisons with other
populations and are classified by the same criteria and methods.

Characteristics of an index

It should be simple to use and accurate.

It should require minimal equipment and expenses.

It should have clear-cut criteria, which are readily understandable.

It should be as free as possible from subjective interpretation.

It should be reproducible by the same examiner or different examiners.

Be amenable to statistical analysis, have validity and reliability.

Not require an excessive amount of time to complete.

Not cause patient discomfort or be otherwise unacceptable to a patient.

Plaque Indices

A plaque index should provide a quantitative assessment. For epidemiologic studies, the relatively
gross indices such as the plaque index (PI, Silness & Loe 1964) are usually sufficient.

In private practice, on the other hand, the collection of a plaque or hygiene index is not intended to
determine the average plaque accumulation, but to record the distribution of plaque in the oral
cavity, i. e., to determine the "plaque picture" of an individual patient. Such a plaque index should
also make it possible to record any improvements in cleaning efficacy during the course of therapy or
during the recall interval.

This is possible only through the use of an index that evaluates all tooth surfaces.

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The following indices will be briefly presented

-Plaque Index (PI, Silness & Loe 1964)

-Interdental Hygiene Index (HYG)

-Hygiene Index (HI) : (Lindah 1983)

GINGIVAL DISEASE

Obviously, a gingivitis case involves a person with gingivitis.

The more difficult part involves deciding when a person has gingivitis.

An early definition of gingivitis simply stated that gingivitis was inflammation of the gingiva." Another
definition in the literature states that gingivitis is inflammation of the gingiva in which the junctional
epithelium remains attached to the tooth at its original level.

How Is Gingivitis Measured?

Gingivitis is measured by gingival indices. Indices are methods for quantifying the amount and severity
of diseases or conditions in individuals or populations.

Indices are used in clinical practice to assess the gingival status of patients and follow any changes in
gingival status over time.

Gingival indices are used in epidemiologic studies to compare the prevalence of gingivitis in
population groups.

In clinical studies, gingival indices are used to test the efficacy of therapeutic agents or devices.

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Gingival Index.

The gingival index (GI) was proposed in 1963 as a method for assessing the severity and quantity of
gingival inflammation in individual patients or among subjects in large population groups Only gingival
tissues are assessed with the GI.

According to this method, each of the four gingival areas of the tooth (facial, mesial, distal, and
lingual) is assessed for inflammation and given a score from 0 to 3.

The criteria for quantifying the severity of gingival inflammation are shown in.

Bleeding is assessed by running a periodontal probe along the soft tissue wall of the gingival crevice.

The scores for the four areas of the tooth can be totaled and divided by four to give a tooth score. By
adding the tooth scores together and dividing by the number of teeth examined, an individual's GI
score can be obtained. The gingival areas of all teeth or selected teeth can be assessed.

A GI score of 0.1 to 1.0 indicates mild inflammation, 1.1 to 2.0 indicates moderate inflammation, and
2.1 to 3.0 indicates severe inflammation.

How Is Periodontitis Measured?

Periodontal Index.

In the early 1950s, gingivitis indices were gaining in popularity; however, no index was available to measure
more advanced stages of periodontal disease.

Motivated by the lack of valid indices for measuring the prevalence of periodontal disease in population groups,
Russell developed the PI .

the PI requires a minimum of equipment a light source, a mouth mirror, and an explorer.

The supporting tissues for each tooth in the mouth are scored according to a progressive scale that gives little
weight to gingival inflammation and relatively great weight to advanced periodontal disease. .

An individual's score is the sum of the tooth scores divided by the number of teeth examined.

The population score is the sum of the individual scores divided by the number of persons examined.

Periodontal probing was not recommended because, according to Russell, it "added little and proved to be a
troublesome focus of examiner disagreement.

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Community Periodontal Index of Treatment Needs (CPITN)

The CPITN was developed in 1978 by the World Health Organization (WHO 1978, Ainamo et al. 1982)
.for epidemiologic studies

.It is today the most often employed index

The major difference between the CPITN and other indices is that it determines not only the severity
of gingivitis and periodontitis, but also provides data concerning the extent of therapy that is
.necessary

The examination is performed with a special probe, which serves more to determine what is normal
(healthy) and what is abnormal (diseased)