Periodontal treatment needs assessed by the use of clinical and radiographic criteria

Abstract

The aim of the present study was to use a decision making model in order to assess the periodontal treatment needs of a random sample of employees in a large Swedish industrial corporation. The model used provided data on critical bone loss limits for different tooth types and ages, beyond which treatment must be initiated, in order to fulfill the goal of maintaining all teeth in a functional state throughout life. A sample comprising 192 subjects belonging to four age strata (31-35 yr, 41-45 yr, 51-55 yr, and 61-65 yr) was involved. From each subject, a full mouth series of intra-oral radiographs were available. The radiographic bone height was assessed at the mesial and distal aspect of all teeth by measuring the distance between the cementoenamel junction and the bone crest. The clinical examination included assessments of plaque, gingivitis, probing pocket depth, and probing attachment level. The results revealed that (i) only 3.1% of all approximal tooth sites exhibited radiographic bone loss exceeding the critical limit, (ii) all individuals and 70% of the approximal tooth sites were in need periodontal treatment when presence of gingival inflammation (bleeding on probing) was employed as the single criterion for therapeutic intervention, (iii) the proportion of individuals and tooth sites requiring treatment amounted to 98% and 27%. respectively, when a probing pocket depth of at least 4 mm was included as an additional criterion, and 54% and 4.1%, respectively, if a probing depth threshold of 6mm was used, while (iv) the use of bleeding on probing in combination with radiographic bone loss beyond the critical limits disclosed a need of treatment in 40% of the subjects and 2.5% of the approximal tooth sites.

Explanatory models for clinical and subjective indicators of periodontal disease in an adult population

“…One could criticize the CPITN-derived clinical measures (Ainamo & Ainamo 1994, Lewis et al 1994, Nyman & Lindhe 1998, Papapanou et al 1990). Radiographically measured periodontal bone level would probably be a better indicator of periodontal disease than probing pocket depth, gingival bleeding and calculus (Nyman & Lindhe 1998).…”

Success rates in periodontal treatment as related to choice of evaluation criteria

“…Therefore, not only the quality of the delivered treatment and the compliance of the patient but also the disease resistance as well as “the clinical importance” of each less responding or non‐responding site or tooth of a patient must be carefully considered during the evaluation procedure since a complementary treatment aimed at achieving perfect periodontal health in all sites of all patients might be an unrealistic goal. Such considerations are further justified, not only by the results of this study but also by the findings reported by Lang et al (1986) and Papapanou et al (1990) that imperfect periodontal health, even when manifested as bleeding on pocket probing, does not necessarily result in progression of the disease. It is suggested that the presented “evaluation criteria staircase” might be a helpful instrument for decision‐making in individually designed and site‐related retreatment of patients with periodontal disease.…”

“…These are standpoints which will have a decisive influence on the need of clinical treatment resources. In fact, Papapanou et al (1990) have shown that the choice of criteria for treatment indications greatly influences the number of patients with treatment need. From a cost‐benefit point of view, it is therefore important that all clinical treatment be based on the evaluation criteria most pertinent to the situation at hand.…”

Preservation of probing attachment and alveolar bone levels in 2 random population samples

“…The causative role of dental plaque m the development of gingival inflammation and the potential conversion of gingivitis to destructive periodontal disease have been thoroughly investigated (Loe et al 1965, Theilade et ai. 1966, Saxe et al 1967, Lindhe et al 1975) and the increased prevalence and severity of periodontal disease with age documented (for review see Papapanou 1989). The epidemiologic studies failed, however, to identify the extent to which ageing per se was responsible for the observed loss of periodontal tissue support.…”

“…The 2nd sample (Papapanou et al, 1990, Table 1) comprised 192 subjects in age groups between 30-65 years and was recruited by random selection among the employees of a large corporation in Gothenburg, Sweden, A clinical examination was performed which included assessment of the same parameters as the ones described for the sample from Japan, Measurements were performed at 4 sites per tooth, at all teeth present 3rd molars excluded.…”