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EPIDEMIOLOGI

PENYAKIT PERIODONTAL

DENTAL EPIDEMIOLOGI :
Adalah studi tentang distribusi & dinamika
penyakit gigi pada populasi dalam masyarakat
Dental epidemiologi dipengaruhi oleh
Usia
Ras/ kelompok
pekerjaan
kerentanan

- kelamin
- tempat tinggal
- karakter sosial
- pemaparan thd agent spesifik

Tujuan :
> Meningkatkan pengertian ttg proses penyakit
untuk mencegah dan mengontrol penyakit
period.
> unt mengembangkan cara pengontrolan &
perkembangan penyakit

INDEKS EPIDEMIOLOGI
Penilaian unt mengkwantisasikan kondisi klinik pada
skala ukuran shg memudahkan dlm membandingkan
antara populasi yg diperiksa dg kriteria & metode yg
sama.
Kriteria Indeks:
mudah digunakan
dpt digunakan pada populasi dlm waktu singkat
dpt menetapkan kondisi klinik seobyek mungkin
dpt digunakan unt menilai keadaan klinik unt satu atau
lebih pemeriksa
mudah dianalisa secara statistik
berhub erat secara numerik thd tingkatan keadaan
klinik dr penyakit yg spesifik

Indeks Periodontal menilai:


1. Derajat peradangan gingiva
2. Derajat kerusakan gingiva
3. Banyaknya akumulasi plak
4. Banyaknya kalkulus
Papillary Marginal Attachment Index (PMAIndex)
Periodontal Index (PI) Russel
Periodontal Disease Index (PDI) Ramfjord
Gingival Index (GI) Loe & Sillness
Community Periodontal Index of Treatment Needs
(CPITN)
dlsb

The Gingival Index (GI) was developed by Loe and Silness to


describe the clinical severity of gingival inflammation as well
as its location.
Bleeding

Inflammation

Points

Appearance
normal

no bleeding

none

slight change in color


and mild edema with
slight change in texture

no bleeding

mild

redness, hypertrophy,
edema and glazing

bleeding on
probing/pressure

moderate

marked redness,
hypertrophy, edema,
ulceration

spontaneous
bleeding

severe

Gingival Index (GI) Loe & Sillness


menilai keparahan gingivitis
Papilla (distofacial)
Marginal (facial)
Papilla (mesiofacial)
Marginal (lingual)

4 SKORING UNIT
(4 PERMUKAAN)

Gingival Indeks = skor tiap gigi


4
Arti hasil skor:
Skor 0 : normal
Skor 2 : peradangan ringan

= sedikit perubahan warna, tdk


ada perdarahan saat palpasi

Skor 3 : peradangan sedang

= kemerahan, uedem, berkilat,


perdarahan pd palpasi

Skor 4 : peradangan berat

= kemerahan nyata, odem,


ulcerasi, cenderung
perdarahan spontan

PERIODONTAL HYGIENE INDEX (HYG)


Yg diperiksa di antara 2 gigi
Mencatat permukaan gigi interdental yg bebas plak dlm persentase
Mirip dg Approximal Plaque Index dr Lange yg mencatat %
akumulasi plak
Untuk mengukur akumulasi plak interdental
Pasien berkumur dg disclosing sol. Dilihat warna yg melekat,
(apakah bebas plak atau tidak )

Prosedur
berkumur dg disclosing sol. dilihat apakah ada pewarnaan atau
tidak pada permuk. Gigi
skor (+) ada pewarnaan ada plak
skor (-) tdk ada pewarnaan bebas plak
dibuat dlm kuadran dr aspek facial & oral (sama dg papilla bleeding
index) yg dicatat pd chart.

Perhitungan skor HYG


HYG = daerah yg bebas plak x 100 =................%
daerah yg diperiksa

Yg digunakan di klinik period.:


Papilla Bleeding Index (PBI)
Indikator yang sensitif pd peradangan gingiva
Untuk menilai keberhasilan pengukuran/ kegagalan alat
dilangsungkan perawatan periodontal
Mencatat intensitas peradangan daerah papillary
Memotivasi pasien ke arah kebersihan mulut yg baik
Probe yg digunakan probe WHO
Yg diperiksa papil fasial dan lingual
Tujuan : Menyadarkan Px ttg ditemukannya daerah penyakit dlm
mulut
OH buruk gingivitis ajar Px dg m lihat didepan cermin dg
probing papillarry tunjukkan gingivitis yg disebabkan oleh plak,
dgn demikian Px sadar bhw daerah yg diprobing merupakan daerah
yg kotor/ plak penyebab gingivitis diharapkan Px dpt termotivasi
unt menjaga OH baik dg membersihkan daerah yg kotor tsb.

Prosedur klinis PBI


dgn tekanan jari yg ringan dg probe period. tumpul dimasukkan dlm
sulcus
Probe ditegakkan dari dasar papil sampai ke ujungnya sepanjang aspek
mesial & distal dr gigi
Menimbulkan perdarahan
Seluruh kuadran diperiksa 20 30 dtk

PBI

= Jumlah Skor perdarahan papil gingiva


Jumlah Total papil yang diperiksa

PERIODONTAL INDEX (PI)


Russell developed an index for measuring periodontal
disease that could be used in population surveys. It
can be based solely upon the clinical examination, or
it can make use of dental X-rays if they are available.
It places greater emphasis on advanced disease.
Scoring:
(1) Each tooth is scored separately according to the
following criteria.
(2) Rule: When in doubt, assign the lower score.

Periodontal Index of Russell


Russell mengembangkan satu indeks untuk mengukur
penyakit periodontal digunakan unt meneliti pd
populasi didasarkan pd pengujian klinis, dapat
menggunakan sinar-X bila tersedia. Penekanan lebih
besar pada penyakit yang berat.
Scoring:
1. Masing-masing gigi diukur secara terpisah berdasar
kriteria.
(2) Aturan: apabila ada keraguan, memberi score yang
lebih rendah.

Additional X-Ray Criteria

Score

Criteria for Field Studies


negative (neither overt inflammation in the
investing tissues, nor loss of function due to
destruction of supporting tissues)

radiographic appearance normal

mild gingivitis (overt area of inflammation in


the free gingivae, but this area does not
circumscribe the tooth)

gingivitis (inflammation completely


circumscribes the tooth, but there is no
apparent break in the epithelial attachment)

(not used in field study)

early, notchlike resorption of the alveolar


crest

gingivitis with pocket formation (the epithelial


attachment is broken, and there is a pocket.
There is no interference with normal
masticatory function, the tooth is firm in its
socket, and has not drifted.

horizontal bone loss involving the entire


alveolar crest, up to half of the length of
the tooth root (distance from apex to
cemento-enamel junction)

advanced destruction with loss of masticatory


function (tooth may be loose; tooth may have
drifted; tooth may sound dull on percussion
with a metallic instrument; the tooth may be
depressible in its socket)

advanced bone loss, involving more than


half of the length of the tooth root, or a
definite intrabony pocket with definite
widening of the periodontal membranes.
There may be root resorption, or
rarefaction at the apex

individual score =
= AVERAGE (scores for all of the teeth in the mouth)
population score =
= AVERAGE(individual scores in population
examined)
Interpretation:
minimum score: 0
maximum score: 8
The higher the score, the more marked the
periodontal disease.

The Community Periodontal Index


of Treatment Needs (CPITN)
CPITN is an epidemiologic tool developed
by the World Health Organization (WHO)
for the evaluation of periodontal disease in
population surveys. It can be used to
recommend the kind of treatment needed
to prevent periodontal disease.

Teeth examined: 2 methods of selection


(1)sextants: 14 teeth on the maxilla and 14 teeth on the
mandible, divided into 3 segments on each
FDI notation maxilla:

(1) 17, 16, 15, 14; (2) 13, 12, 11, 21,
22, 23; (3) 24, 25, 26, 27
FDI notation mandible: (4) 47, 46, 45, 44; (5) 43, 42, 41,
31, 32, 33; (6) 34, 35, 36, 37
third molars are not used unless they function in place of
the second molars
(2) use of index teeth: 5 teeth on the maxilla and 5 teeth on
the mandible
FDI notation maxilla: (1) 17, 16; (2) 11; (3) 26, 27
FDI notation mandible: (4) 47, 46; (5) 31; (6) 36, 37

Dental evaluation
(1)A special probe is used to to evaluate the depth of
the dental sulcus.
(2) The teeth are examined for supragingival or
subgingival calculus.
(3) Any bleeding after gentle probing is noted.

Evaluation
The worst finding in each sextant is coded according to
the
table below..
The maximum code for the entire mouth is used for the
treatment recommendation.

Finding

CODE

pathologic pockets >= 6 mm deep

pathologic pockets 4-5 mm deep

supragingival or subgingival
calculus

gingival bleeding after gentle


probing

no signs of periodontal disease

Treatment recommendation
maximum score 0: no need for additional treatment
maximum score 1: need to improve personal oral
hygiene
maximum score 2: need for professional cleaning of
teeth, plus improvement in personal oral hygiene
maximum score 3: need for professional cleaning of
teeth, plus improvement in personal oral hygiene
maximum score 4: need for more complex treatment
to
remove infected tissue

The Oral Hygiene Index


is a method for classifying the oral hygiene status of a patient. It can be
used over time to monitor progress in corrective interventions.
Dental segments
upper right posterior: distal to the right cuspid on the maxillary arch
upper anterior: mesial to the right and left first bicuspids on the
maxillary arch
upper left posterior: distal to the left cuspid on the maxillary arch
lower right posterior: distal to the right cuspid on the mandibular arch
lower anterior: mesial to the right and left first bicuspids on the
mandibular arch
lower left posterior: distal to the left cuspid on the mandibular arch
Surfaces on each segment
buccal (outer)
lingual (inner)

Evaluating teeth
Only fully erupted (occlusal and incisal surface has
reached the occlusal plane) permanent teeth are scored.
Third molars and incompletely erupted teeth are not
scored because of the wide variations in heights of clinical
crowns.
The buccal and lingual debris scores are both taken on
the tooth in a segment having the greatest surface area
covered by debris.
The buccal and lingual calculus scores are both taken on
the tooth in a segment having the greatest surface area
covered by supragingival and subgingival calculus.

Points
Grading Debris
no debris or stain present

soft debris covering not more than one third of the


tooth surface, AND/OR the presence of extrinsic
stain without other debris regardless of surface area
covered

soft debris covering more than one third, but not


more than two thirds, of the exposed tooth surface

soft debris covering more than two thirds of the


exposed tooth surface

debris index =
= (SUM(points along buccal surface for all segments present) +
SUM(points along lingual surface of all segments present)) / (number of
segments present)

Grading Calculus

Points

no calculus present

supragingival calculus covering not more than one third of the


exposed tooth surface

supragingival calculus covering more than one third but not


more than two thirds of the exposed tooth surface, AND/OR
the presence of individual flecks of subgingival calculus around
the cervical portion of the tooth

supragingival calculus covering more than two thirds of the


exposed tooth surface AND/OR a continuous heavy band of
subgingival calculus around the cervical portion of the tooth

calculus index =
= (SUM(points along buccal surface for all segments present) +
SUM(points along lingual surface of all segments present)) / (number
of segments present)
oral hygiene index =
= (debris index) + (calculus index)

Gingival Bone Count


The gingival bone count is a composite score based on the
gingival condition and degree of bone loss affecting a person's
teeth. This can be used to evaluate periodontal health, especially
in epidemiologic studies.
Scoring
The gingival score is based on the clinical examination.
The bone score is based on the clinical examination and
evaluation of dental X-rays.
A single gingival score and a single bone score is generated
for each tooth studied.
A mean for each score is then computed for the whole mouth.

Finding

Score

Parameter
gingival score

bone score

negative

mild gingivitis involving the free gingiva (margin,


papilla, or both)

moderate gingivitis involving both free and attached


gingiva

severe gngivitis with hypertrophy and easy hemorrhage

no bone loss

incipient bone loss or notching of alveolar crest

bone loss about one fourth of root length, or pocket


formation one side not over one half of root length

bone loss about one half of root length, or pocket


formation one side not over three fourth root length;
mobility slight

bone loss about three quarters of root length, or pocket


formation one side to apex; mobility moderate

bone loss complete; mobility marked

gingival bone score =


= SUM((gingival score) + (bone score)) / (number of teeth examined)
= (mean gingival score) + (mean bone score)
Interpretation

minimum score: 0
maximum score: 8
The higher the score, the more serious the
periodontal disease.

The Sulcus Bleeding Index (SBI)


can be used to assess a patient for gingivitis, which can be important in the
prevention of periodontal disease. This was initially called the "PM Index",
but the name was changed to prevent confusion with the "PMA Index".
Number of teeth examined: 16 (the anterior 4 in each quadrant, 2 on maxilla
and 2 on mandible)
Teeth in each quadrant
(1) medial incisor
(2) lateral incisor
(3) cuspid
(4) first premolar
Surfaces on each tooth probed: 4
(1) M labial
(2) M lingual
(3) P mesial
(4) P distal
Total number of readings: 64

Each surface is examined grossly for color and swelling, then a probe is
gently placed in the sulcus to see if bleeding occurs.
Sulcus Probing

Points

Appearance
healthy

no bleeding

apparently healthy with no change in


color and no swelling

bleeding on probing

change in color due to inflammation; no


swelling or macroscopic edema

bleeding on probing

change in color due to inflammation;


slight edematous swelling

bleeding on probing

obvious swelling

bleeding on probing

spontaneous bleeding; changes in color;


marked swelling with or without
ulceration

bleeding on probing

Interpretation
The total number of surfaces showing each of the scores (0 to 5) is used
to evaluate the distribution of changes associated with gingivitis.
minimum sum of all SBI scores: 0
maximum sum of all SBI scores: 320

Periodontal Index of Russell


Russell developed an index for measuring periodontal
disease that could be used in population surveys. It can
be based solely upon the clinical examination, or it can
make use of dental X-rays if they are available. It places
greater emphasis on advanced disease.
Scoring:
(1) Each tooth is scored separately according to the
following criteria.
(2) Rule: When in doubt, assign the lower score.

Additional X-Ray Criteria


Criteria for Field Studies
negative (neither overt inflammation in the
investing tissues, nor loss of function due to
destruction of supporting tissues)

radiographic appearance normal

Score
0

mild gingivitis (overt area of inflammation in the


free gingivae, but this area does not circumscribe
the tooth)

gingivitis (inflammation completely circumscribes


the tooth, but there is no apparent break in the
epithelial attachment)

(not used in field study)

early, notchlike resorption of the alveolar crest

gingivitis with pocket formation (the epithelial


attachment is broken, and there is a pocket. There
is no interference with normal masticatory
function, the tooth is firm in its socket, and has not
drifted.

horizontal bone loss involving the entire alveolar


crest, up to half of the length of the tooth root
(distance from apex to cemento-enamel
junction)

advanced destruction with loss of masticatory


function (tooth may be loose; tooth may have
drifted; tooth may sound dull on percussion with a
metallic instrument; the tooth may be depressible
in its socket)

advanced bone loss, involving more than half of


the length of the tooth root, or a definite
intrabony pocket with definite widening of the
periodontal membranes. There may be root
resoprtion, or rarefaction at the apex

individual score =
= RATA2 (scores for all of the teeth in the mouth)
population score =
= RATA2 (individual scores in population examined)

Interpretation:
minimum score: 0
maximum score: 8
The higher the score, the more marked the periodontal disease