EPIDEMIOLOGY

Heidi Emmerling, RDH, PhD DH 112 Periodontics I Spring 2008

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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 2

Epidemiology
Prevalence of gingivitis in the US:
50% of the overall population 47% of employed population 53% of seniors Males more than females
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 3

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 sites equivalent to a GI score of 2
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 4

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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 5

Epidemiology
Pattern of distribution of periodontitis
Ranges from 5 pocketing sites in the average 18year-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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 6

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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 7

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 8

Indices
Purpose: 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 and symptoms in the population
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 9

Indices
Plaque and debris indices
Plaque index of Silness and Loe (Pl I) Simplified Oral Hygiene Index (OHI-S) of Greene and Vermillion

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 10

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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 11

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 12

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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 13

OHI-S

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 14

Pl-I versus DI-S/OHI-S

Pl-I of 2 means thinmoderately thick layer of plaque at gingival margin DI-S of 2 means that 2/3 of the tooth is covered by debris

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 15

Indices
Bleeding indices
Gingival Index of Loe and Silness (GI) Sulcus Bleeding Index (SBI)

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 16

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 in texture, 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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 17

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 18

Sulcus Bleeding Index (SBI)

Mesial, distal, lingual, facial surfaces Check for bleeding 30 seconds after withdrawing probe 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 without color change 5 = spontaneous bleeding, color change, significant swelling with or without ulceration
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 19

Indices
Periodontal Indices
Russells Periodontal Index (PI) Periodontal Disease Index of Ramfjord (PDI)

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 20

Russells PI
Weighed more towards bone loss than gingival inflammation Developed in 1950s and provided important information that was not previously quantified

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 21

PI (Cont)
Scores are added and averaged 0 = no inflammation or loss of function 1 = mild gingivitis, inflammation of free gingiva but not circumscribing the tooth 2 = gingivitis with inflammation circumscribing the tooth 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 on percussion and depressible in pocket
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 22

Ramfjords PDI
Measures gingivitis and periodontitis Evaluates #3, #9, #12, #19, #25, #28 as representative of the entire dentition Scores are added and averaged

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 23

PDI (Cont)
Gingivitis
0 = negative 1 = mild gingivitis (free gingiva) 2 = moderate gingivitis free and attached gingiva) 3 = severe gingivitis with hypertrophy and hemorrhage

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 24

PDI (Cont)
Periodontal disease (gingivitis score is disregarded)
4 = pocket depths on 2 or more surfaces extending 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 surfaces extending more than 6 mm apical to the CEJ

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 25

Indices
Calculus Indices
Calculus index of the OHI-S/ Greene and Vermillion Volpe Manhold probe method of calculus assessment (VM)

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 26

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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 27

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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 28

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 29

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 30

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
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 31

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 32

Dental Hygiene Role

Lots of periodontal disease in the US Bleeding, gingivitis, calculus, pockets

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 33

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 provide comprehensive dental hygiene care
DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 34

DHYG 112B Periodontics I H Emmerling, RDH, PhD Spring 2008 35