Ercília Leal DINI
Department de Preventive Dentistry, Faculty of Dentistry, UNESP, Araraquara, SP, Brazil
Correspondence: Dra. Ercília Leal Dini, Caixa Postal 684, 14801-970 Araraquara, SP, Brasil. e-mail: email@example.com
Braz Dent J (2001) 12(1): 51-55 ISSN 0103-6440
INTRODUCTION | MATERIAL AND METHODS | RESULTS | DISCUSSION | RESUMO | REFERENCES
The aim of this study was to compare the periodontal conditions in 7-15-year-olds from Araraquara, SP, Brazil in 1998 with data from 1995. A systematic random sample was drawn from the population of children and adolescents enrolled in all public schools in 1998. The survey was conducted by trained examiners using the CPITN and WHO diagnostic criteria. Results showed an increase in the percentage of students of all ages with healthy periodontal conditions (from 14% in 1995 to 33% in 1998; p<0.01). An increase in the mean number of healthy sextants (from 3.2 to 4.4; p<0.0001), a decrease in the mean number of bleeding sextants (from 2.5 to 1.2; p<0.0001) and no difference in the mean number of sextants with calculus were also observed. At the age of 15, 54% of the students had 5-6 healthy sextants in 1998 compared to 19% in 1995 (p<0.01). Despite the improvement observed in the periodontal conditions, efforts must be increased in order to achieve the WHO goal for the year 2010 of no more than one sextant affected by bleeding or calculus at the age of 15.
Key Words: preventive dentistry, epidemiology, periodontal diseases, prevalence.
The worldwide acceptance of the CPITN/CPI (Community Periodontal Index of Treatment Needs) system has proved to be a simple and effective method for measuring and monitoring the prevalence and severity of periodontal diseases at the community level (1). It has also provided the basis for the WHO periodontal health goals for the year 2000 (2) and more recently for the year 2010 (3).
The CPITN has been increasingly adopted in dental health services and has proven to be a useful tool for planning and monitoring periodontal treatment needs and establishing population periodontal health goals (4,5). However, limited data have been reported on the use of CPITN for evaluating changes in periodontal status of a given population after implementation of an oral health program (6).
An urban school-based oral health prevention/treatment program providing individual and community procedures was implemented in Araraquara, State of São Paulo, Brazil, in 1989, with priority for 7-12-year-old children. Oral hygiene instruction was part of the program with dental plaque disclosure and supervised toothbrushing with fluoridated toothpaste once every three months (7). Lack of baseline data on periodontal conditions in this population made it impossible to evaluate the effectiveness of the implemented program since its inception. The first data of the periodontal conditions of this population was collected in 1995 (8).
The aim of this study was to report the periodontal conditions in 7-15-year-old children and adolescents from Araraquara, state of São Paulo, Brazil, in 1998 and to compare this with the 1995 data.
MATERIAL AND METHODS
The study population consisted of 16,539 7-15-year-old schoolchildren and adolescents enrolled in all urban public schools in Araraquara, SP, Brazil, in 1998. The sample size for each age was defined using the sampling procedure for a finite population (9). The level of significance was set at 5 per cent and the level of precision at 0.4 (10). The data used for comparison were obtained in the 1995 epidemiological dental survey carried out in the student population of Araraquara (11). From the class lists of the 35 urban public schools, previously ordered by age and using systematic random sampling, 966 individuals aged 7 to 15 years were selected. Two previously trained examiners carried out the examinations in dental chairs at the schools, using artificial light and WHO periodontal probes.
The CPITN (Community Periodontal Index of Treatment Needs) was used to assess periodontal conditions, based on WHO criteria and registers (10). Examinations were carried out on six index teeth (teeth 16, 11, 26, 36, 31, 46), and included scoring for bleeding and calculus. The diagnostic criteria used and the examinations were conducted in the same manner as in the 1995 survey. One of the examiners participated in both surveys and for the present study both dentists were trained and evaluated by the other examiner who had participated in the 1995 survey. Intra-examiner Kappa values for the first and second examiners were K = 0.90 and 0.92, respectively. The inter-examiner Kappa value was 0.87.
Comparisons between the two surveys were made by calculating the SND (standard normal deviate) (12) for the difference between percentages of subjects by age according to the highest CPITN score. SND was also used to compare the differences between the percentages of subjects aged 7, 12 and 15 years with 3 or more healthy sextants and with 5-6 healthy sextants in 1995 and 1998. Mann-Whitney rank sum test was used to compare the mean number of sextants according to CPITN between the two surveys. The 95 per cent level of confidence was used for testing.
Preliminary results showed no differences in periodontal conditions
between sexes. The results were thus combined. Table
1 shows the number of subjects examined and the percentage distribution
according to the highest CPITN score, age and year of survey. Despite the
decrease in the percentage of individuals and in the mean number of sextants
with bleeding, this condition was the most frequently observed in all ages
in both surveys (Tables 1 and 2)
with the exception of 15-year-old adolescents who showed the greatest percentage
of healthy periodontal conditions (absence of bleeding and/or calculus)
in 1998 (Table 1). There was
an increase in the percentage of children and adolescents with healthy periodontal conditions (from 14 per cent in 1995 to 33 per cent in 1998). Statistical analysis showed significant differences (p<0.01) in all ages between 1995 and 1998, with the exception of 7-year-olds (Table 1). An increase in the mean number of healthy sextants between 1995 and 1998 was observed in all ages, with statistically significant differences (p<0.0001) (Table 2). The differences in the percentages of children and adolescents and in the mean number of sextants with calculus in the three-year period were not statistically significant (Tables 1 and 2).
Figure 1 shows the percentages of subjects aged 7, 12 and 15 presenting 3 or more healthy sextants according to age and year of survey. The percentage of 15-year-olds with 3 or more healthy sextants increased from 61% in 1995 to 80% in 1998 (p<0.01). Similarly, Figure 2 shows the percentage of children and adolescents with 5-6 healthy sextants according to age and year of survey. The percentage of individuals presenting 5-6 healthy sextants increased since 1995. The greatest increase observed was in 12-year-old children (37%) (p<0.01), followed by the 15-year-old adolescents (35%) (p<0.01).
Results of the present study showed an improvement in the periodontal conditions of children and adolescents, with an increase in the percentage of subjects and mean number of healthy sextants in all ages over the 3-year period. Despite the improvements observed and the decrease in the percentage of children and adolescents with bleeding, this condition was still the most frequently observed. To date, there have not been many studies using the CPITN to assess the periodontal conditions in children. One study carried out with Saudi Arabian schoolchildren also reported bleeding as the most frequently observed condition (13). However, children of the same age from Indonesia and Central America were reported as having calculus as the most prevalent condition (4,14). Similar results to those found in the present study were reported amongst 15-year-old adolescents in some European (15) and North American countries (16).
In the present study, the percentage of 15-year-olds with calculus was smaller than that observed in the 1995 survey and that reported for Brazilian adolescents of the same age in 1986 (42%) (17). The results of the present study also showed smaller percentages of 15-year-olds with calculus than those reported for adolescents from Japan (18), Africa (16) and Central and South American countries (4,5).
It must be remembered that this study compares data from two surveys (1995 and 1998). Factors other than the access to the oral health program may have contributed to the changes in the prevalence and severity of periodontal status in this population. This population had access to fluoridated water and toothpaste and the prevalence of caries has been declining since 1989 (7,11).
The slight increase in the percentage of 7-9-year-old children with calculus in the 3-year period calls for a reinforcement of oral hygiene instruction in this age group. In the baseline survey carried out in 1995 and taking into account the periodontal status of the population at that time and the available resources, two goals were proposed following WHO guidelines (2,3). The first goal was to have 100% of 15-year-olds showing three or more healthy sextants by the year 2000. The second goal was to have all 15-year-olds with 5-6 healthy sextants by the year 2010 (8).
According to the results of the present survey, 80% of the 15-year-olds showed 3 or more healthy sextants and 54% of them had 5-6 healthy sextants, compared to 61% and 19%, respectively in 1995. These increases in percentages of children and adolescents with healthy sextants reflect the improvements shown in periodontal conditions of this population over the 3-year period. Although this population had access to an oral health program and despite the improvements observed, efforts still need to be directed towards maintaining the observed improvements and achieving the WHO goal for the year 2010 of no more than one sextant affected by bleeding or calculus at the age of 15.
The author would like to thank Ioneide M.G. Brandão, Fátima C.C. Mendonça and Ana Lígia R. Foschini for their contributions during the development of this work.
Dini EL. Modificações nas condições periodontais de crianças e adolescentes de Araraquara, Brasil: 1995-1998. Braz Dent J 2001;12(1):51-55.
O objetivo do estudo foi reportar a prevalência das condições
periodontais de crianças e adolescentes com idades entre 7 e 15
anos em Araraquara, São Paulo, Brasil, em 1998 e comparar esta
com os resultados obtidos em estudo realizado em 1995. Processo de amostragem sistemática foi utilizado para selecionar uma amostra de crianças e adolescentes matriculados em todas as escolas públicas em 1998. O levantamento foi conduzido por examinadoras treinadas utilizando o CPITN e os critérios de diagnóstico da OMS. Os resultados mostraram um aumento na porcentagem de estudantes de todas as idades com periodonto sadio (de 14% em 1995 para 33% em 1998; p<0,01). Também foram observados aumento na média de sextantes sadios (de 3,2 para 4,4; p<0,001) e diminuição no número médio de sextantes com sangramento (de 2,5 para 1,2; p<0,001). Não se observou modificação no número médio de sextantes com cálculo. Na idade de 15 anos, 54% dos estudantes apresentavam de 5-6 sextantes sadios em 1998, comparados com 19% em 1995 (p<0,01). Apesar da melhoria observada nas condições periodontais desta população, esforços devem ser direcionados com o propósito de alcançar a meta da OMS para o ano 2010, de que na idade de 15 anos não mais que um sextante seja afetado por sangramento ou cálculo.
Unitermos: odontologia preventiva, epidemiologia, doenças periodontais, prevalência.
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Accepted August 1, 2000
Braz Dent J 12(1) 2001