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The Epidemiology of periodontal diseases

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The Epidemiology of periodontal diseases

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  1. The Epidemiology of periodontal diseases Department of Preventive Dentistry School & Hospital of Stomatology Wuhan University Minquan Du 杜民权

  2. Periodontal diseases • Gingivitis is defined as an inflammatory process of the gingiva in which the junction epithelium, although altered by the disease, remains attached to the tooth at its original level • Periodontitis is also an inflammatory condition of the gingival tissues, characterized by loss of attachment of the periodontal ligament and the bony support of the tooth • From the viewpoint of public health that periodontal diseases are slowly progressing inflammatory diseases.

  3. Periodontal diseases • Local factors: oral hygiene, dental plaque and calculus • Systemic factors: unusual syndromes associated with defects, malnutrition and hormonology imbalance

  4. The 3rd National Oral Helath Survey 2005 • 12岁组牙龈出血为57.7% • 35~44岁人群牙周炎患病率41.0% • 65~74岁人群牙周炎患病率52.3%

  5. 指 数 An Index is a graduated, numerical scale with upper and lower limits, with scores in the scale corresponding to specific criteria 指数:表明某种现象变动的程度。指标作用或 批示作用的标识。用数值级差作标准,测量 和比较疾病的扩展范围和严重程度

  6. An Ideal Index • 简单 Simplicity • 价廉 Acceptability • 有效 Validity • 可靠 Reliability • 敏感 Sensitivity • 能用统计学方法处理 Quantifiability

  7. The Measurement of Periodontal Diseases • In contrast to the stability of the DMF index for caries over a 50-year period, the philosophical basis for measuring periodontal disease has changed several times over a shorter time. • Clinical measures used for gingivitis and periodontitis were first described 40 years ago.

  8. Periodontal health index 1. Oral hygiene index – simplified 简化口腔卫生指数 2. Plaque Index 菌斑指数 3. Turesky Modified Quigley-Hein Plaque Index 4. Gingival Index 牙龈指数 5. Sulcus bleeding index 龈沟出血指数 6. Community periodontal index 社区牙周指数

  9. Oral hygiene index – simplified (OHI-S) • Debris index 软垢指数 • Calculus index 牙石指数

  10. Oral hygiene index – simplified • 牙面:16 11 26 31唇面,36 46舌面 • 检查方法:视诊,探诊 • 计分方法: 牙面计分之和 • 软垢、牙石计分= 受检牙面数 • 个人计分=简化牙石计分+简化软垢计分

  11. Criteria for DI 0 = No debris in the surface of the teeth. 牙面无软垢 1 = Debris covered less than one third area of the surface. 软垢覆盖面积占牙面1/3以下 2 = Debris covered between one third to two third area of the surface. 软垢覆盖面积为牙面1/3与2/3之间 3 = Debris covered more than two third area of the surface. 软垢覆盖面积占牙面2/3以上

  12. 0 1 2 3 debris index

  13. Scores and criteria for CI-S 0 = No calculus in the surface of the teeth. 龈上、龈下无牙石 1 = Calculus covered less than one third area of the surface. 龈上牙石面积占牙面1/3以下 2 = Calculus covered between one third to two third area of the surface.龈上牙石面积占牙面1/3~2/3之间,或牙颈部有散在的龈下牙石 3 = Calculus covered more than two third area of the surface.龈上牙石面积占牙面2/3以上,或牙颈部有连续而厚的的龈下牙石

  14. 0 1 2 3 calculus index

  15. Plaque Index, PLI 菌斑指数 • The principal difference between the PLI and OHI-S approach is that the PLI scores plaque according to its thickness at the gingival margin rather than its coronal extent, a measure claimed to be more valid. • 检查方法: 视诊+探诊 • 检查时用探针轻划牙面,根据菌斑的量和厚度记分 • PLI可以检查全口牙面,也可检查指数牙 • 每颗牙检查4个牙面:mesial, distal, buccal, and lingua surfaces

  16. Criteria for use of the Plaque Index 0 = no plaque in the gingival area . 龈缘区无菌斑 1 = a film of plaque adhering to the free gingival margin and adjacent area of the tooth, the plaque may be recognized only by running a probe across the tooth surface. 龈缘区的牙面有薄的菌斑,但视诊不可见,若用 探针尖的侧面可刮出菌斑 2 = moderate accumulation of soft deposits within the gingival pocket, on the gingival margin and/or adjacent tooth surface, which can be seen by the naked eye. 在龈缘或邻面可见中等量菌斑 3 = abundance of soft matter within the gingival pocket and/or on the gingival margin and adjacent tooth surface 龈沟内或龈缘区及邻面有大量软垢

  17. 0 1 2 3 plaque index

  18. Turesky Modified Quigley-Hein Plaque Index • Quigly & Hein, 1962 Turesky, 1970 • Ramfjord指数牙:16, 21, 24, 36, 41, 44 • 检查方法: 菌斑染色剂使菌斑染色,根据面积记分

  19. Scores and criteria for QT 0=牙面无菌斑 1=牙颈部龈缘处有散在的点状菌斑 2=牙颈部连续薄带状菌斑宽度<1mm 3=牙颈部菌斑面积1mm~牙面1/3 4=菌斑覆盖面积占牙面1/3~2/3 5=菌斑覆盖占面积2/3或以上

  20. 0 1 2 3 4 5 Turesky Modified Quigiey-Hein PL

  21. Gingival Index, GI 牙龈指数 • Loe and Silness, in the early 1960s • 观察牙龈情况,检查牙龈颜色和质的改变,以及出血倾向 • 检查方法:钝头牙周探针,结合视诊和探诊 • 全口牙或指数牙,4个牙周围的牙龈

  22. Scores and criteria for the Gingival Index 0 = Normal gingiva 牙龈健康 1 = Mild inflammation: slight change in color, slight edema. No bleeding on probing 牙龈的色有轻度改变并轻度水 肿,探诊不出血 2 = Moderate inflammation: redness, edema, and glazing. Bleeding on probing. 牙龈中等炎症:牙龈色红,水肿光 亮,探诊出血 3 = Severe inflammation: marked redness and edema. Ulceration. Tendency to spontaneous bleeding. 牙龈明 显红肿或有溃疡,并有自动出血倾向

  23. 0 1 2 3 gingival index

  24. 群体患牙龈炎程度的衡量标准 牙龈指数 牙龈炎流行程度 0.1-1.0 轻度 1.1-2.0 中度 2.1-3.0 重度 由于牙龈指数能反映牙龈炎症的有无与程度,且临床应用简便,无论在牙周疾病的现况调查中或实验流行病学研究中,多采用此标准

  25. Sulcus bleeding index, SBI龈沟出血指数 • Muheman & Son, 1971 • 反映牙龈炎活动状况 • 检查方法:视诊+探诊 • 检查时观察牙龈颜色和形状,牙周探针轻探龈沟,观察出血情况 • 不用菌斑染色

  26. Scores and criteria For SBI 0 =龈缘和龈乳头外观健康,轻探龈沟后不出血 1 =龈缘和龈乳头外观健康,轻探龈沟后出血 2=牙龈因炎症而有颜色改变,无肿胀或水肿,探诊后出血 3=牙龈有颜色改变和轻度水肿,探诊后出血 4=牙龈不但有色的改变并明显肿胀,探诊后出血 5=牙龈有色的改变,明显肿胀,有时有溃疡,探诊后出血或自动出血

  27. Community periodontal index, CPI社区牙周指数 • WHO, 1982, worldwide use • 不仅反映牙周组织的健康状况,也反映牙周的治疗需要情况 • 操作简便,重复性好,适合于大规模的口腔流行病学调查

  28. A specially designed lightweight CPI probe with a 0.5 mm ball tip is used, with a black band between 3.5 to 5.5 and rings at 8.5 and 11.5 mm from the ball tip.

  29. Community Periodontal Index • 检查方法:探诊为主、结合视诊 • 检查项目:牙龈出血 牙石 牙周袋深度

  30. 指数牙 17-14 13-23 24-27 47-44 43-33 34-37 • 16 11 26 27 • 47 46 31 36 37 16 11 26 46 31 36

  31. 检查顺序:按顺时针方向检查每一颗功能牙 • 探诊力量:应在20g以下,简单测试方法是将CPI探针插入拇指甲沟内,轻轻压迫显示指盖发白且不造成疼痛和不舒服的感觉为适宜力量

  32. Community Periodontal Index • WHO规定: A sextants should be examined only if there are two or more teeth present which are not indicated for extraction. 每个区段内必须有2颗或2颗以上功能牙,并 且无拔牙指征,该区段才做检查。检查区段 内以最重情况记分

  33. Community Periodontal Index • 成年人的后牙区段,有时缺失一颗指数牙或有拔牙指 征,则只检查另一颗指数牙。 • 如果一个区段内的指数牙全部缺失或有拔牙指征时,则检查此区段内的所有其余牙齿,以最重情况记分。 • 每颗指数牙的所有龈沟或牙周袋都须检查到。 • 每个区段两颗功能牙检查结果,以最重情况记分。 • 六个区段中记分最高区段的记分则作为个人CPI记分。

  34. Codes and criteria used in the CPI 0 – Healthy 健康 1 - Bleeding observed, directly or by using a mouth mirror, after probing. 牙龈探诊后出血(直接或口镜观察) 2 - Calculus detected during probing, but all of the black band on the probe visible 探诊有牙石存在,但探针黑区全部可见 3 - Pocket 4-5 mm (gingival margin within the black band on the probe 牙周袋4-5毫米(探针黑区部分在龈下) 4 - Pocket 6 mm or more (black band on the probe not visible ).牙周袋6毫米或以上(探针黑区全部在龈下) X - Excluded sextant (less than two teeth present). 除外区段(余留牙不足2颗) 9 - Not recorded 不做记录

  35. CPI

  36. 4 2 3 2 2 4 0 1 0 1 0 1 1

  37. Community Periodontal Index • 优点:操作简便,容易掌握 • 缺点: (1)牙龈出血和牙石被高估 (2)没有记录牙周附着丧失的程度 牙周袋有真性牙周袋和假性牙周袋两种 有时候牙周探针深度不能真实反映牙周组织 的破坏程度, 牙周组织的附着水平是客观反映牙周炎的指标

  38. Community Periodontal Index of Treatment Needs 计分标准 0= 不需要治疗 1= 需要口腔卫生指导以改进个人口 腔卫生状况 2= 需要口腔卫生指导及洁治 3= 需要口腔卫生指导、洁治和复杂 牙周治疗

  39. The epidemic characteristics of periodontal diseases 流行特征

  40. WHO criteria for perodontal conditions (15-year-old)