EPIDEMIOLOGY OF

PERIODONTAL DISEASE
Dr.Natasha Zaidi
Senior Lecturer Periodontology
 “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.”
PURPOSES OF EPIDEMIOLOGY
 To determine the amount and distribution f a
disease in a population

 To investigate causes for the disease

 To apply this knowledge to the control of the

disease
PREVALENCE:

Proportion of persons in a population

who have the disease of interest at a
given point in or period of time.
 It measures the burden of disease in

population
INCIDENCE:
It is the average percentage of unaffected
persons who will develop the disease of
interest during a given period of time.
 It indicates the risk or probability that a

person will become a case

 Incidence = no of new cases of diseases

no of persons in population at
risk
 Prevalence is a measure of amount of disease
existing in a population

while,

 Incidence is a measure of the occurrence of

new cases
Epidemiologic study designs

 Cross-sectional studies
 Cohort studies
 Case-control studies
INDICES
 Indices are methods for quantifying the
amount and severity of diseases or conditions
in individuals or population.
TYPES OF INDICES
Plaque Index

 Definition: an index for estimating the status

of oral hygiene by measuring dental plaque
that occurs in the areas adjacent to the
gingival margin.
 No plaque
0
A film of plaque adhering to the free
gingival margin and adjacent area of the
tooth, which can not be seen with the
naked eye. But only by using disclosing
1 solution or by using probe.

Moderate accumulation of deposits

within the gingival pocket, on the
gingival margin and/ or adjacent tooth
surface, which can be seen with
2 the naked eye.
Abundance of soft matter within the
gingival pocket and/or on the tooth and
DEBRIS AND CALCULUS INDEX
 The Oral Hygiene Index is composed of the
combined Debris Index and Calculus index,
representing the amount of debris or calculus
found on the tooth surface
DEBRIS INDEX
0 No debris or stain present

Soft debris covering less than one third of the tooth

1 surface, or presence of extrinsic stains without
other debris regardless of surface area covered

Soft debris covering more than one third, but less

2 than two thirds, of the exposed tooth surface.

Soft debris covering more than two thirds of the

3 exposed tooth surface.
CALCULUS INDEX
0 No calculus present
Supragingival calculus covering not more than one third of
1 the exposed tooth surface.
Supragingival calculus covering more than one third but
less than two thirds of the exposed tooth surface or the
2 presence of individual flecks of subgingival calculus around
the cervical portion of the tooth or both.
supragingival calculus covering more than two third of the
3 exposed tooth surface or a continuous heavy band of
subgingival calculus around the cervical portion of the
tooth or both.
PAPILLARY MARGINAL ATTACHED
GINGIVAL INDEX (PMA)
 An index used for recording the prevalence
and severity of gingivitis by noting and
scoring three areas: the gingival papillae (P),
the buccal or labial gingival margin (M), and
the attached gingiva (A).
 PAPILLARY
0 Normal, no inflammation
1 Mild papillary engorgement, slight increase
in size
2 Obvious increase in size of gingival papilla,
bleeding on pressure
3 Excessive increase in size with spontaneous
bleeding
4 Necrotic papilla

5 Atrophy and loss of papilla

 MARGINAL
0 Normal, no inflammation visible
1 Engorgement, slight increase in size and no
bleeding
2 Obvious engorgement and bleeding upon
pressure
Swollen collar, spontaneous bleeding,
3 beginning infiltration into attached gingiva.
4 Necrotic gingivitis
Recession of the free marginal gingiva
5 below the cemento-enamel junction as a
result of inflammatory changes
 ATTACHED
0 Normal; pale rose, stippled
Slight engorgement with loss of stippling,
1 change in color may or may not be present.
Obvious engorgement of attached gingiva
2 with marked increase in redness, pocket
formation present.
3 Advanced periodontitis, deep pockets
evident
Gingival index
Gingival index was proposed in 1963 as a
method of assessing the severity and quantity of
gingival inflammation in individual patients or
among subjects in large population groups.

*NOTE :
1)only gingival tissues are assessed with
GI.
2) Each of the four gingival areas of the
tooth( facial, mesial, distal and lingual) is
assessed for inflammation.
0 Normal gingiva

1 Mild inflammation: slight change in color and slight

edema; no bleeding on probing
2 Moderate inflammation: redness, edema, and glazing;
bleeding on probing
3 Severe inflammation: marked redness and edema;
ulceration; tendency to spontaneous bleeding.
Modified gingival index
Introduced two important changes to the GI;
1) Elimination of gingival probing to assess the
presence or absence of bleeding

2) Redefinition of the scoring system for mild

and moderate inflammation
0 absence of inflammation
1 Mild inflammation; slight change in color;
little change in texture of any portion of,
but not the entire, marginal and papillary
gingival unit
2 Mild inflammation; criteria as above, but
involving the entire marginal or papillary
gingival unit.
3 Moderate inflammation; glazing, redness,
edema, and/or hypertrophy of the marginal
or papillary gingival unit.
Severe inflammation; marked redness,
edema, and/or hypertrophy of the marginal
4 or papillary gingival unit; spontaneous
bleeding, congestion, or ulceration
SULCUS BLEEDING INDEX
 An index of gingival inflammation in which
bleeding is measured from four gingival units
(mesial and distal papillary units and labial
and lingual marginal units), using a
periodontal probe with a 0.5mm diameter tip.
The scoring range around eight anterior teeth
(four maxillary and four mandibular)
0 Gingiva of normal texture and color; no
bleeding
1 Gingiva apparently normal, bleeding on
probing
2 Bleeding on probing, change in color, no
edema
3 Bleeding on probing; change in color,
slight edema
4 Bleeding on probing, change in color and
obvious edema
5 Spontaneous bleeding and marked edema
 GINGIVAL ASSESSMENT

0 Absence of inflammation
Mild to moderate inflammatory gingival
1 changes not extending all around the
tooth.
Mild to moderate severe gingivitis
2 extending all around the tooth
Severe gingivitis characterized by
3 marked redness, tendency to bleed and
ulceration
Periodontal index
 An index that estimates the degree of
periodontal disease present in the mouth by
measuring both bone loss around the teeth
and gingival inflammation; used frequently in
the epidemiologic investigation of
periodontal disease
 Each erupted tooth is examined

 Russell chose the scoring values (0,1,2,6,8) in

order to relate the stages of the disease
scored in a survey to the clinical condition
observed

 Low scores are given for gingival

inflammation and higher scores when the
alveolar bone has been destroyed.
 Negative : there is neither overt inflammation in
0 the investing tissues nor loss of function due to
destruction of supporting tissues.
Mild gingivitis: there is an overt areas of
1 inflammation in the free gingiva, but the area
does not circumscribe the tooth
Gingivitis : inflammation completely
2 circumscribes the tooth, but there is no
apparent break of epithelial attachment
Gingivitis with pocket formation :the epithelial
attachment has been broken and there is a
6 pocket, there is no interference with normal
masticatory function, the tooth is firm in its
socket and has not drifted.
Advanced destruction with loss of masticatory
function: the tooth may be loose; may have
8 drifted; may sound dull on percussion and may
Limitations of Periodontal Index
 It does not discriminate between moderate
and severe gingivitis

 It does not measure loss of attachment;

graded all pockets of 3mm or more equality

 Scored gingivitis and periodontitis on the

same weighted scale
PERIODONTAL DISEASE INDEX
Ramfjord introduced PDI to overcome
shortcomings of other indices.

1) 6 pre selected teeth were used to examine

PDI ( max right first molar, max left central
incisor, max left first premolar, mandibular
left first molar, mandibular right central
incisor and mandibular right first premolar.
This selection of teeth became known as the
ramfjord teeth.
 THE BASIC PERIODONTAL
EXAMINATION (BPE)
 The Basic Periodontal Examination (BPE) is
derived from the Community Periodontal
Index of Treatment Needs (CPITN), which was
developed as a screening tool to enable the
prevalence of periodontal disease in a
community to be summarized.
CPITN
 The index comprises six codes (0–4 and *).An
individual patient’s periodontal status can be
summarized by six numbers.
CPITN PROBE
 The use of a CPITN probe (Figure 10.2) is
mandatory. This has a ball end 0.5 mm in
diameter. A color-coded area extends from
3.5–5.5mm. A probing force in the order of
20–25 g is recommended. This corresponds
to gentle pressure; pain during probing
indicates that too much force is being
applied.
Code 0 Healthy gingival tissues with no bleeding after
probing.
Bleeding on probing, plaque present, but no
Code 1 calculus or
defective restoration margins, pockets <3.5mm.
Bleeding on probing, calculus detected or defective
Code 2 restoration margins but pockets <3.5mm.

Pocket within the color-coded area, i.e. pocket

Code 3 >3.5 mm–<5.5mm.

Color-coded area disappears, indicating pocket

Code 4 >5.5mm.

Denotes the presence of furcation involvement or

Code* attachment loss >7mm.
 BPE codes 1–3 are deemed suitable for non-
specialist periodontal care.
 Code 4 and * frequently suggest that the

complexity is such that the patient may need

referral for specialist periodontal care. This is
particularly so if the patient is young and
suffering from aggressive forms of
periodontitis, or has a complicating medical
history, e.g. uncontrolled diabetes.
THANKYOU