Marcio Fernando de Moraes GRISI1
Sérgio L. SALVADOR2
Walter MARTINS Jr.3
Cincinato Rodrigues SILVA-NETO1,3
1Faculdade de Odontologia de Ribeirão Preto and
2Faculdade de Ciências Farmacêuticas de Ribeirão Preto Universidade de São Paulo, Ribeirão Preto, SP, Brasil
3Universidade de Ribeirão Preto (UNAERP), Ribeirão Preto, SP, Brasil
Braz Dent J (1999) 10(2): 93-97 ISSN 0103-6440
| Introduction | Material and Methods | Results | Discussion | References |
Key Words: CPITN, BANA, enzymatic test, periodontal disease.
A new perspective became available to periodontal health services when
the Community Periodontal Index of Treatment Needs (CPITN) was developed
as an initiative of the World Health Organization (Ainamo et al., 1982).
The index was adopted by the International Dental Federation in 1985 for
use in epidemiologic studies and for patient evaluation in clinical dentistry.
In 1990, the CPITN was slightly modified and the Periodontal Screening
and Recording (PSR) was instituted, endorsed by the ADA and AAP. Several
lines of evidence currently indicate that many forms of periodontitis are
due to the presence of a finite number of bacterial species in subgingival
plaque (Loesche et al., 1982, 1985, 1987; Slots and Genco, 1984; Moore,
1987; Dzink et al., 1988).
Loesche et al. (1990) developed a rapid and simple diagnostic test for periodontal pathogens, the BANA (N-benzoyl-DL-arginine-naphthylamide) assay. Clinical trials have shown that the test results of the paper BANA assay are highly correlated with Treponema denticola, Porphyromonas gingivalis and Bacteroides forsythus (Loesche et al., 1987, 1990, 1992). These findings indicate that the BANA test might be clinically useful for detecting activity and individuals who need periodontal treatment. In the present investigation the ability of subgingival plaque to hydrolyze BANA (Perioscan®) was correlated with the CPITN scores.
Material and Methods
The study was conducted on 53 patients, 48 women and 5 men, average
age 38.8 years old, who were seen at the Clinical Service of the Dental
School of Ribeirão Preto, University of São Paulo. The patients
had not been previously treated for periodontal disease, were classified
as individuals with adult periodontitis, had not been using antibiotics
or any other medications during the last 6 months, and had no systemic
disease. The women were not pregnant and were not on contraceptive medication.
The upper and lower sextants were examined in each patient (O’Leary, 1967)
and CPITN scores ranging from zero to 4 were recorded, using a PWHO periodontal
probe according to the criteria proposed by Ainamo et al. (1982). The need for treatment in a sextant was recorded when one or more teeth were present and were not indicated for extraction.
The clinical criterion used to establish the area of material collection for BANA hydrolysis was the surface with the greatest probing depth in each tooth of the sextant examined. Subgingival plaque material was collected from 281 sites using Gracey 5/6 periodontal curettes positioned in the deepest areas of the periodontal pockets in order to remove subgingival plaque. No procedure was applied for the removal of supragingival plaque. The material was collected by a single examiner before any treatment. To avoid contamination from one site to another when collecting material from the same patient, collection was performed according to the criteria of Murai et al. (1985). The BANA hydrolysis test was performed using Perioscan® cards (Oral-B Laboratories, Redwood City, CA, USA), plaque samples were incubated for 15 min at 55oC, and the cards were read by a single examiner on the basis of a change in color. Data were analyzed statistically at the Statistics Center of FORP/USP using the t-test, the Kendall test and the chi-square test.
Table 1 indicates that of the 281 sites
analyzed, 5 were scored as zero, corresponding to 1.8% of the sites classified
by the CPITN. Three of these presented a negative result in the BANA test,
corresponding to 60.0% of the five sites with zero CPITN, and 2 presented
positive results in the BANA test, corresponding to 40.0% of the five sites
classified as zero CPITN. If we consider the total number of 281 sites
analyzed, the 3 sites classified as zero CPITN and negative to the BANA
test correspond to 1.1% of the total.
To determine if the results obtained by the two processes were correlated, considering the contingency table, the Kendall test showed a value of 0.18689, with a significance of 0.00095. The Kendall test is a nonparametric test that considers a sample of N independent pairs of observations (Xi, Yj).
A simple correlation test between the CPITN and a positive BANA test showed a value of 0.9937, with a significance of 0.0006, and the correlation between the CPITN and a negative BANA test was 0.8558, with a significance of 0.0516.
Because of the very small number of sites (11) with zero and 1 CPITN values, corresponding to 3.9% of the total number of sites examined, we worked with the remaining 270 sites and obtained the results described in Table 2.
A total of 136 sites were classified as CPITN 2 (50.7% of the 270 sites analyzed). Of these, 107 were positive to the BANA test, corresponding to 78.8% of the sites classified as CPITN 2 and the percentage of sites classified as CPITN 2 and positive to the BANA test was 40.0% in relation to the total number of 270 sites studied. The table also shows that 229 of the 270 sites analyzed (84.8%) were positive to the BANA test and 41 (15.2%) were negative. Of the 41 BANA-negative sites, 29 (70.7%) presented a CPITN equal to 2, 8 (19.5%) a CPITN equal to 3 and 4 a CPITN equal to 4 (9.8%).
By not considering each test individually, but rather crossing both tests, we can see that the 29 BANA-negative sites with a CPITN equal to 2 corresponded to 10.7% of the total of 270 sites. The 107 BANA-positive sites with a CPITN equal to 2 corresponded to 40.0% of the total, while the 8 BANA-negative tests with a CPITN equal to 3 corresponded to 3.0% of the sites analyzed. The 90 BANA-positive sites with a CPITN equal to 3 corresponded to 33.0% of the sites examined. On the other hand, the 4 BANA-negative tests with a CPITN equal to 4 corresponded to 1.5%, and the 32 BANA-positive sites with a CPITN equal to 4 corresponded to 11.9% of the 270 sites analyzed.
By considering the data as a contingency table, we applied the chi-square test to determine whether there was any type of dependence between the variables analyzed and the result was 7.89639 with a significance of 0.0192. The Kendall test was also applied and, as expected, continued to be significant, with a value of 0.1479 and a significance of 0.01132.
The present results show that 136 of the 281 sites analyzed had a CPITN
of 2, with a highly significant BANA-positive test (107 sites). A CPITN
equal to 3 was also significantly BANA positive (Tables 1 and 2). These
findings clearly demonstrate the relationship between the CPITN and the
BANA test indicating the presence of periodontal infection with anaerobic
microorganisms (BANA positive).
Individual analysis of the results obtained showed that 83.2% of the 281 sites examined presented scores of 2 and 3, whereas only 36 sites (12.8%) with a score of 4 required a complex treatment involving a surgical approach. These observations agree with those reported by Caldas and Bervique (1992) and Campos Jr. et al. (1992). Although formation of moderate pockets (3.5 to 5.5 mm) was present in approximately 30% of the adult population, the need for complex treatment (pockets deeper than 5.5 mm) was observed in only 1.3% of the individuals (Beck et al., 1984).
With respect to BANA hydrolysis, the present results demonstrate a significant correlation between increased pocket depth and positive results (Figure 1), in agreement with data reported by Syed et al. (1984), Loesche et al. (1987), Bretz and Loesche (1987), Schmidt et al. (1988), and Grisi et al. (1996).
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Correspondence: Prof. Marcio Fernando de Moraes Grisi, Departamento de Cirurgia e Traumatologia Buco-Maxilo-Facial e Periodontia, Faculdade de Odontologia de Ribeirão Preto, USP, Av. do Café, s/n, Monte Alegre, 14049-904 Ribeirão Preto, SP, Brasil. E-mail: email@example.com
Accepted June 12, 1999
Eletronic publication: April, 2000