Laboratory animal models in periodontology

Animal models are needed to objectively evaluate the pathogenesis of human periodontal diseases and its various treatment modalities. Selection of the appropriate animal model depends on the similarity of the periodontium and the nature of the disease to that of humans. The more commonly used animal models for studying the pathogenesis of periodontal disease, use of implants and guided tissue regeneration have been dogs and nonhuman primates. Periodontal disease in rodents has not been found to be as closely related to the human varieties. Rats and hamsters are best suited for caries and calculus research. Ferrets may be a promising new model for studying periodontal disease and calculus formation. Variables unique to each animal species are manifested by a wide range of clinical and histopathological features. Different species have distinct diets, habits, life spans, tissue structures, host defense mechanisms and genetic traits. This article describes the diversity seen in animal models used to study microbiological, immunological, and clinical features of periodontal disease and its prevention and treatment.     

Epidemiology and preventive direction of periodontology in China

OBJECTIVE: The aim of this work was to estimate the present periodontal problems of people in China, based on an epidemiological investigation of adults. MATERIAL AND METHODS: The data were collected from the northwest, southwest, northeast and east regions (400 subjects from each region) of China. All subjects were over 25 years of age. About half of the subjects were farmers and about half were urban professionals. Everyone was asked to fill out a questionnaire and to undergo a professional oral examination. Periodontal health status was evaluated by a simplified oral hygiene index (OHI-S), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PD), clinical attachment loss (CAL), and tooth mobility. RESULTS: Of the 1590 subjects enrolled in this investigation, 45.7% were male, 45.5% were farmers, and the remaining were urban professionals, and 27.7% of the subjects were smokers. There was a significant difference in the educational background but not smoking between the rural and urban groups. While 34.9% of the subjects in the urban group brushed only once per day, 56.1% of the subjects in the rural group did so. The prevalence of bleeding during brushing was 71.1%, while about 61.4% of the subjects know nothing about scaling. All periodontal indices were significantly higher in males than in females and higher in the rural group than in the urban group. PD, CAL and tooth mobility increased with age. The percentage of sites with CAL>3 mm in the rural group (49.5%) was significantly higher than that in the urban group (37.5%). Both current and former smokers showed increased CAL than non-smokers. CONCLUSION: Gingivitis and periodontitis are common findings in China. Most Chinese have no knowledge of common periodontal prevention and treatment and very few have regular dental care. The data of this study suggest that age, smoking, and limited education are significantly associated with Chinese adult periodontal attachment loss. Preventive periodontal care and education should be reinforced in the future by establishing relevant oral health projects.     

Periodontal treatment needs in 12–16-yr-old children from Santo Domingo

The purpose of this study was to determine the periodontal treatment needs, using the CPITN, in 12-16 yr-old children from private and public schools from Santo Domingo, Dominican Republic. A total of 1080 children was studied (540 in private schools and 540 in public schools). More children from private schools were seen without signs of periodontal disease than in public schools. More children from private schools showed no need for treatment. There was no statistical difference between children from private and public schools regarding the treatment need categories I and III. However, for the treatment need II category (oral hygiene-scaling), the children from public schools showed a slight increase in need over the private schoolchildren. Combining private and public schools, 12.9% of the 1080 children examined needed no treatment, 5.9% needed treatment I, 80.8% needed treatment II, and 0.4% needed treatment III.     

Costs of periodontal and prosthodontic treatment and evaluation of oral health in patients after treatment of advanced periodontal disease

Abstract Retrospective estimations of dental care costs of periodontal and prosthodontic treatment and evaluation of oral health in 37 patients with advanced periodontal disease were carried out. Measures of their subjective evaluation of oral health 7–10 yr after the treatment are presented as a health profile and as indices in single numbers. The relations between oral health as an index and the dimensions in the health profile are analyzed. Dental care costs for treatment in the mandible was SEK 35 550. for the maxilla SEK 45 380 and for both jaws SEK 74 230. After the treatment oral health as well as general health were in excess of 75 on a 0 to 100 scale. Chewing ability, comfort and aesthetics were the variables found to significantly affect the subjective oral health. Oral health in terms of periodontal and prosthodontic conditions was maintained over the observation period.     

Periodontal treatment need of the Finnish population aged 30 years and over

A representative sample (n = 8000) was drawn from the population aged 30 years and over, registered as living in Finland. Periodontal disease status was recorded according to the modified Periodontal Treatment Need System (PTNS). Plaque retentions were examined separately. Of the subjects with four or more teeth 3.4% had a healthy periodontal status, while 10.2% of the jaw quadrants were healthy. Plaque retentions were found in 96.6% of the subjects and 90.9% of the jaw segments. Periodontal treatment need was calculated in three ways and was 195 +/- 111 (S.D.) min when the calculation was based on WHO recommendations (1978). Number of teeth, age, sex, caries and filling scores, and education explained about 30% of the treatment need when tested by multiple linear regression analysis.     

Periodontal health status and treatment needs among the elderly

The numbers of dentate elderly are growing rapidly in all industrialized countries, and epidemiological information about their oral health is urgently needed. Our study is part of the population-based Helsinki Ageing Study (HAS), and this paper describes the periodontal health status as well as the need for periodontal treatment among the dentate elderly born in 1904, 1909, and 1914 and living in January, 1989, in Helsinki, Finland (n = 175). The dental examinations were carried out during 1990 and 1991 at the Institute of Dentistry, University of Helsinki, Finland. The subjects' periodontal health was recorded by the CPITN (Community Periodontal Index of Treatment Needs) method. The mean number of remaining teeth was 15.1 among men and 14.0 among women, with the mean number of remaining sextants 3.7 and 3.5, respectively. Healthy periodontal tissues (CPI = 0) were found in 7% of the subjects. Bleeding on probing (CPI = 1) was recorded in 6%, and calculus and/or overhanging margins of restorations (CPI = 2) in 41% of the subjects, as the worst finding. Altogether, 46% of the subjects had deep periodontal pockets, 35% with at least one 4- to 5-mm pocket (CPI = 3), and 11% with at least one ≥ 6-mm pocket (CPI = 4). Overall, 93% of the subjects required oral hygiene instruction, 87% scaling and root planing, and 11% complex periodontal treatment. The periodontal treatment need was significantly higher in men than in women; however, no significant differences were observed among the three age cohorts. The need for complex periodontal treatment was unexpectedly low, probably explained by the fact that there were many missing teeth, especially molars, perhaps lost due to poor periodontal health.     

A method for defining the level of periodontal treatment need in a population of 15-year-old schoolchildren

ABSTRACT In a public dental service with scarce resources, the presence of gingivitis in teenage children cannot necessarily be considered as indicating treatment need. However, it is suggested that early bone loss may be an important indication for treatment in teenage children and the aim of the present study was to determine whether the presence of early bone loss in 622 15-year-old children assessed by the measurement of loss of attachment could be predicted from more readily identifiable factors such as gingival bleeding or sub-gingival calculus. However, such screening tests will make errors by including “healthy subjects” or excluding “diseased subjects”. The acceptable balance of these two kinds of error is a public health decision, a decision which may be affected by a number of variables, including the public's and profession's attitudes to the disease, the effectiveness of available treatments and the resources available.     

Photographic-assisted diagnosis and treatment planning

The advent of digital photography allows the practitioner to show the patient the photographs immediately, to co-diagnose, and to work with the patient chairside or in a consult room while showing the patient some simple imaging techniques, such as whitening the teeth, making the teeth look longer, and showing the effects of orthodontics or veneers to get better alignment and other factors of smile design and esthetic dentistry. This article describes recommended digital dental photographic equipment, how to produce the standard series of diagnostic dental photographs, photographic assisted diagnosis and treatment planning including a discussion of anthropometrics and cephalometrics, and digital imaging techniques.     

Prediction of periodontal treatment capacity

This study analyzes factors having influence on dentists' capacity to give periodontal therapy. The data was collected by the questionnaire from 134 randomly selected Finnish dentists. The effects were examined by two- and multiway frequency tables. The results indicated that the time since graduation had the strongest single effect. Also the prediction categories dealing with continuing education and scientific interest were related to periodontal capacities of dentists. The combined effects of certain variables as sex, type of position and place of practice indicate that the cumulation of certain favourable factors is needed to accomplish periodontal therapy in Finland. It was concluded that the promotion of periodontal care can be realized reliably by improved levels of undergraduate and postgraduate education.     

Periodontal treatment need in a Finnish industrial population

A periodontal study was conducted in a paper mill in Finland. To adapt the Periodontal Treatment Need System (PTNS) to a Finnish adult population the estimates of Finnish periodontologists were used. The mean estimate of periodontal treatment need was 97 +/- 58 (s.d.) min per person and 32 +/- 18 min per jaw segment. Periodontal treatment need increased with age. No significant differences in periodontal treatment need by sex, education, type of employment, regularity of working hours or frequency of dental visits were observed. Adjusted family income and toothbrushing frequency did not produce significant differences in periodontal treatment need, except in the group having four dentulous jaw segments. The groups using sugar, other sweetening agents or neither of these, mainly in coffee or tea, differed significantly: the non-users of sugar had lowest treatment time and those who used other sweetening agents than sugar had highest treatment time.     

The result of periodontal treatment in relationship to various background factors

The aim of the present study was to investigate whether various background factors of patients play a role for the result of periodontal treatment and whether their attitudes towards prevention change during treatment. The study was carried out as a retrospective analysis using data obtained during periodontal treatment of 143 patients. The result of the treatment was assessed by the recording of presence or absence of gingival bleeding by probing prior to treatment and after 3, 6 and 12 months. The background factors were assessed by letting the patients answer a questionnaire about their dental history, tooth cleaning habits and knowledge about their own dental health situation. Moreover, they responded to statements regarding their attitudes to and general knowledge about prevention of dental diseases. 89 of the patients were asked again 3 months later to respond to these statements. After treatment, 3 groups were formed on the basis of the 12-month gingival score: a successful treatment group (S) comprising 79 patients with a gingival bleeding score of 20% or less, a non-successful treatment group (N) comprising 49 patients with more than 20% tooth surfaces showing bleeding and a drop-out group (D) of 15 patients who did not appear for the 12-month examination. No statistically significant difference was found in the various background factors of patients with a successful or a non-successful treatment result. However, dropping out showed a significant relationship to unfavorable dental beliefs and young age (P less than 0.005). Following treatment, the patients responded more favorably to statements about oral hygiene as a preventive means.     

The need for periodontal treatment in an urban population

Abstract The need for periodontal treatment was estimated in a group of the citizens of Oslo. A considerable treatment need was found in spite of the high dentist/population ratio in the area. The need for surgical treatment increased with age. Estimated treatment time was higher in males than in females.     

Cone beam computed tomography (CBCT) for diagnosis and treatment planning in periodontology: systematic review update

Clinical Oral Investigations - To update the findings of a systematic review from the year 2016 on the evidence for the accuracy and potential benefits of cone beam computed tomography (CBCT) in...     

Application of the Community Periodontal Index of Treatment Needs (CPITN) in a population of young Brazilians

Recently WHO has launched an index for assessing the periodontal treatment needs of a population in terms of resources required. This Community Periodontal Index of Treatment Needs was applied in 308 Brazilian 15-yr-old schoolchildren from a population with a high prevalence of periodontitis. The results showed that all subjects needed some kind of care. Totally, 4133 time units were required. Most of the time needed was for motivation and instruction in oral hygiene, and scaling. Several individuals assigned for complex treatment due to pockets deeper than 5.5 mm showed no signs of radiographic bone loss, and in the cases with bone loss, the lesions were few and small. The CPITN therefore seemed to overestimate the need for treatment in this young population. To overcome this problem, it was suggested that complex treatment should not be included in planning of systematic periodontal care for young populations, and that subjects with true periodontal lesions should be given priority in community programs.     

Modified IOTN: an orthodontic treatment need index for use in oral health surveys

This paper reports the results of a study of the reliability of a modified version of the Index of Orthodontic Treatment Need (IOTN) for use in oral health surveys. Twelve non-specialist dental examiners were trained in the use of the Modified IOTN using a standardised teaching protocol lasting approximately 1.5 hours. Following a school-based calibration exercise it was found that nearly all the examiners achieved either good or excellent agreement (mean Kappa=0.74). The average sensitivity and specificity scores were 0.90 and 0.84, respectively. The Modified IOTN appears to overcome the training and reliability problems that often accompany the use of orthodontic indices by non-specialists in oral health surveys.     

Dental Needs of Elderly Hostel Residents in Inner Melbourne

BACKGROUND: The purpose of this study was to determine the oral health status and treatment needs of elderly hostel residents in Melbourne. METHOD: One hundred and seventy-five subjects aged 65+ were selected from 20 hostels within a 10 km radius of Melbourne's central business district. RESULTS: Subjects were clinically examined and interviewed using a standard questionnaire. In the course of the clinical examination, coronal caries, root caries, periodontal disease, denture status and related treatment needs were assessed. The mean age of the subjects was 83.7, the majority of whom were female (80 per cent). About 35 per cent of the sample were dentate. The mean number of teeth present among dentate persons was 13.8, the mean coronal caries experience was 24.9 DMFT and mean root caries was 2.3 R-DF. Of the dentate subjects, 46 per cent required at least one restoration for coronal caries and 30 per cent required at least one restoration for root caries. Most dentate subjects had calculus and none had deep pockets, therefore, indications for periodontal treatment did not include complex care. More than 50 per cent of lower full dentures were retained unsatisfactorily and about half of the total number of subjects required prosthetic treatment. CONCLUSIONS: Although there was a high number of treatment needs, most requirements involved simple technologies that could be delivered by auxiliaries.     

Normative and self-perceived orthodontic treatment need in Nigerian school children

Abstract

Objective. The aim of this study was to assess the normative and self-perceived need for orthodontic treatment in Nigerian children, and to evaluate distribution of orthodontic treatment need according to gender and age. Materials and methods. The sample consisted of 441 randomly selected school children, aged 11–18 years in Benin City, Nigeria. The subjects were further sub-grouped according to gender (229 males and 212 females) and age (246 11–13 years old and 195 14–18 years old). The Dental health Component (DHC) and Aesthetic Component (AC) of Index of Orthodontic Treatment Need (IOTN) were used to assess orthodontic treatment need normatively. Self-perceived need was evaluated by asking the subjects to rate their dental aesthetics on the Aesthetic Component scale of IOTN. Chi-square tests were used to evaluate gender and age differences in distribution of treatment need. Results. A definite need for orthodontic treatment was found among 21.5% (grades 4–5 of DHC) and 6.3% (grades 8–10 of AC) of the subjects; 3.9% of the subjects perceived a definite need for orthodontic treatment (grades 8–10 of AC). There were no statistically significant gender and age differences in distribution of orthodontic treatment need among the subjects (p > 0.05). Conclusion. The study revealed a need for orthodontic treatment in slightly more than one fifth (21.5%) of this sample of Nigerian children. The sample population has a lower need on aesthetic grounds and their normative and self-perceived orthodontic treatment needs were not influenced by gender and age.     

Orthodontic treatment need prior to treatment and 5 years postretention

Objectives : To assess orthodontic treatment need prior to treatment and 5 years postretention in a large university sample. Methods: A random sample of 920 patients (400 male and 520 females) from the Department of Orthodontics and Oral Biology, University of Nijmegen, the Netherlands, were included in this study. Dental casts were evaluated using the Index of Orthodontic Treatment Need (IOTN) at the pretreatment (TP) and 5-year postretention stages (T5). The mean age at TP was 12.2±3.0 years and at T5 21.6±3.1 years. At TP and T5 the aesthetic component (AC) and the dental health component (DHC) were assessed The difference between TP and T5 was compared for males and females and tested by the t -test. The changes in AC, DHC and treatment need categories were described at TP and at T5. Results: On the basis of combined AC and DHC treatment need categories, 83% of the patients fell into the Definite e need d category prior to treatment and 10% of the treated patients were categorised as having "Definite need" 5 years postretention. No significant differences were found between males and females for the change in AC and DHC between TP and T5. Conclusions: The results indicate that the policy used in the department for patient selection gives priority to patients with a high treatment need. The results also provide a general impression of treatment outcome utilising the IOTN to analyse the change in the treatment need categories.     

Symptoms of depression and anxiety in relation to dental health behavior and self-perceived dental treatment need

The purpose of this study was to investigate the dental health behavior and self-perceived dental treatment need, in relation to depressive symptoms and symptoms of anxiety, among a general population drawn from a sample of 31-yr-old-men and women born in Northern Finland in 1966 (n = 8463). The dental health behavior included toothbrushing frequency and the frequency of dental check-ups. Depressive symptoms, as well as symptoms of anxiety, were determined on the basis of the Symptom Checklist-25 (SCL-25). The participants were also asked about their education and family income. Subjects with a high number of depressive symptoms had lower toothbrushing frequency as well as a lower frequency of dental visits than subjects with no or only a few depressive symptoms. Morover, the self-perceived dental treatment need was more common among those with a high number of depressive symptoms. Symptoms of anxiety were significantly associated with lower toothbrushing frequency. The results support the view that there is an increased risk for impaired dental health among subjects with depressive symptoms or symptoms of anxiety.     

Differences in dental treatment plan and planning for drug-addicted and non-drug-addicted patients

Abstract This study investigated whether dental treatment plans and planning of general practitioners are different for addicted and identical non-addicted patients. Dental practitioners (n=500) were sent a questionnaire with information on and questions about treatment for either an addicted or an identical non-addicted patient; response rate was 41%. Loglinear analysis showed that after controlling for the influence of four demographic variables (sex, age, number pf patients and number of National Health Service insured patients), the treatment plans made for addicted patients were less elaborate than those for the non-addicted. For the addicted, fillings or frames were proposed more often, whereas for non-addicted patients more often crowns or bridges were proposed. Extraction instead of filling was more often proposed for the addicted patient. Less elaborate treatment for addicted patients corresponds to the way dentists specialized in treating drug addicts work, with one exception: extraction should be avoided whether a patient is addicted or not. Treatment planning did not differentiate for addicted and non-addicted patients, whereas dentists specialized in treating addicted patients do recommend an adjusted treatment plan for the addicted.