摘要:

Abstract.The aim of the present overview is to evaluate the periodontal conditions in European populations. Study was made of a number of extensive surveys of periodontal diseases carried out in a number of European countries, primarily North West Europe. These surveys often provide considerable detail. However, international comparisons are difficult to perform because of the different methods applied. Therefore, the latest overviews of results of periodontal surveys, based on the CPITN method and stored in the WHO Global Oral Data Bank, are given for the age groups 15–19 years and 35–44 years. Based on this approach, the conclusions are as follows. Trends and prevalences in periodontal health and disease in Europe are clear, at least up to the age of 60 year. Severe periodontal destruction seems to be a limited problem, seldom leading to tooth loss before age 50 and certainly not a major cause of edentulousness before age 60. For a large majority, in most of the populations observed, the progress of periodontal destruction seems to be compatible with the retention of a natural, functioning dentition into older age. However, the periodontal problem might still be of considerable magnitude and importance as bleeding on probing is widely encountered in the younger age groups. Furthermore, 5–15% of populations affected by a serious, irreversible condition at age 40 years is high, compared with most other dis

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02300.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.Epidemiologic surveys have provided data for health planning by estimating prevalence and incidence of diseases in populations. New ways of presenting epidemiologic data on periodontal diseases have changed our understanding of their extent and severity, and conversion of prevalence data into treatment need estimates has proved difficult. Furthermore, new concepts of the pathogenesis of periodontal diseases have questioned the validity of epidemiologic methods currently used. Treatment need assessments vary considerably between studies even when prevalence data from the same populations are similar. This may be due to lack of described goals for periodontal health. Various aspects of the concept of need for treatment are discussed. It is suggested that periodontal treatment need on a population level is defined as the intervention needed in order to change the existing periodontal condition to the described goal. Thus, treatment need assessments will have to include descriptive epidemiologic data as well as defined periodontal health goals. It is recommended that goals are described in terms compatible with the indicators used in the epidemiologic description of the disease status.

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02301.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.There is relatively little severe periodontal disease in populations in Europe. The public health significance is therefore debateable. The fact that the costs of treating the disease are high because of the organization of dental care, qualifies it as a dental public problem. In addition, the symptoms of periodontal diseases such as bleeding, halitosis, gingival recession and tooth loss have an impact on many people, and we have sufficient information to control the common forms of the disease. The goals for dental health can be expressed in terms of health, disease, health education and health promotion and training. A reasonable objective is to achieve a rate of loss of attachment compatible with maintaining at least upper and lower shortened arches for a lifetime. 4 strategies are considered: a high risk, a population, a secondary prevention strategy or a combination of the three. A combination of the 3 is needed to achieve the objective of maintaining a functional, aesthetically and socially acceptable natural dentition for the lifespan of most people. The balance of effort should be heavily weighted towards the population strategy. If the strategy is adopted, the need for treatment will be reduced and treatment will be more successful.

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02302.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.Clinicians are usually inclined to reduce data obtained from diagnosis to a simpler form such as “yes or no” answers in order to obtain useful parameters for daily practice. It should be realized, however, that the diagnostic process very rarely exhibits “black and white” situations. Rather the evaluation of numerous “grey levels” is imperative. The diagnostic process, therefore, remains always incomplete and inaccurate, and it represents an evaluation of probabilities rather than certainties. For this reason, the diagnostician should realize and understand the mathematical relations between the information provided by diagnostic tests and the clinical situation actually present at the time of the test. This will allow one to convert diagnostic results into therapeutic procedures with a high degree of confidence. Since results from diagnostic tests are quite often used to decide on treatment, complex data are reduced to simple dichotomy, such as presence or absence of disease, normal or abnormal conditions, etc. In order to react to diagnostic tests in an ordinal, dichotomous manner, the clinician has to choose a particular level of a test at which he initiates treatment without having the assurance that this level represents the one and only standard at which treatment has to b

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02303.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.In the present paper, the onset age of periodontal destruction is discussed. Results of epidemiological studies have shown that with increasing age, the prevalence of periodontitis in a population increases. Data show that after the age of 40 years, the % of the population affected by periodontitis remains rather constant. If it is supposed that the incidence of periodontitis after the age of 40 is zero (no new cases), then extractions resulting in edentulousness due to periodontitis should lead to a decrease of the prevalence of periodontitis. However, after the age of 40 years, the prevalence of periodontitis remains about the same, whereas edentulousness due to periodontitis increases. This suggests that even at a relatively old age, the onset of periodontitis may occur. On the other hand, periodontal destruction has also been found in the primary dentition. Especially on the basis of family studies and studies on localized juvenile periodontitis patients, it can be supposed that in a substantial part of the population, periodontal destruction starts early in life.

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02304.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.7 patients completed 2 years of observation following initial therapy. Triplicate probing measurements were used to identify sites with ≥ 1 mm of probing attachment change between any 2 of the following time points; immediately pre‐instrumentation; immediately post‐instrumentation; 3 months; 12 months and 24 months. 24% of sites lost probing attachment directly due to instrumentation. 12% of sites lost probing attachment at 24 months compared to pre‐instrumentation, but over 1/3 of these lost attachment at the time of instrumentation. 47 sites lost probing attachment from post‐instrumentation to 24 months. 22 of these sites were shallow buccal or lingual sites and their attachment apparatus may have remodelled. The initially deeper of these sites displayed other clinical features more consistent with inflammatory periodontitis. Sites that initially gained probing attachment due to treatment but which later lost were identified. These sites may have had a reversal of the enhanced epithelial adaption. 17 other patients were monitored over a period of 31/2 years and sites losing probing attachment were identified using linear analysis of regression. The diagnostic predictability of clinical signs to reveal probing attachment loss at 31/2 years was calculated. In general, predictability values improved with increasing time interval. Increase in probing depth, particularly if combined with a high frequency of bleeding, showed the highest predictability. The effect of therapy on probing attachment levels should be considered in the identification of sites with probing attachment loss. Persistent bleeding, combined with high residual probing depths or increase in probing depth, may be a useful adjunct to probing attachment loss in identifying disea

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02305.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.Dentitions seriously compromised by periodontal disease are often in need not only of cause‐related periodontal therapy of high quality but also of relevant prosthetic rehabilitation. Contrary to traditional claims, clinical investigations published during the last 2 decades demonstrate that, if adequately treated and controlled, such dentitions can carry fixed, cross‐arch bridges on an extremely reduced amount of periodontium, with a good long‐range prognosis. It has also been shown that a markedly reduced but healthy and favourably distributed periodontium supporting such constructions can withstand occlusal forces of considerable magnitude. Another controversal topic, related to fixed bridges, involves indications and centra‐indications for cantilever segments. Some clinical investigations demonstrate a markedly increased risk of failure if the fixed bridge is provided with cantilever units, while other controlled studies with defined specifications on the design of the constructions exhibit a high success rate after 8 years or more also for bridgework where 2 or 3 cantilever units are included. The force pattern along cantilever segments of both tooth‐supported and implant‐supported bridges has been extensively studied. The results show that the force distribution depends not only on the occlusal contact pattern and the dimensioning of the cantilever beam, but also on the type of prosthetic construction in the opposite jaw occluding with the cantilever segment. The free‐standing, implant‐supported bridge has recently become an important treatment modality for rehabilitation of the partially edentulous jaw, and follow‐up studies demonstrate a high success rate. Prosthetic connections between natural teeth and implants have also been reported to have a good prognosis without incorporation of elastic elements in the constructions, provided that factors such as occlusal force pattern, tooth mobility and beam dimensioning are taken into consideration. Other factors influencing the force distribution in such constructions afe size, type and number of implants as well as the

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02306.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.Recent studies of microbial epidemiology emphasizing the genetic organization and distribution of organisms associated with orofacial infections have led to new insights into the possible origins of pathogenicity. Studies into genetic heterogeneity, acquisition and transmission of these organisms have been markedly advanced by the utilization of the powerful technique of genomic DNA fingerprinting. Characteristic fingerprints for each bacterial isolate can be produced by cleavage of high molecular weight genomic DNA by restriction endonucleases. It is assumed that each DNA fingerprint represents a clonal type. In this report, we review and analyze studies of the epidemiology of bacteria associated with orofacial infections with an emphasis on periodontal disease. Studies of nontypable (NT)Haemophilus influenzaeassociated with recurrent otitis media illustrate the utility of this technique. DNA fingerprinting clearly demonstrates genetic heterogeneity of NTH. influenzaeisolates, and clonality of infection of any individual. Furthermore, DNA fingerprinting has shown that the same clonal type is seen in siblings concurrently suffering from otitis media, suggesting horizontal transmission within the family. Studies ofmutans Streptococcialso show extensive genetic heterogeneity and show vertical transmission of a predominant clonal type only from mother to infant, but not from father to infant. Studies ofActinobacillus actinomycetemcomitansshow considerable genetic heterogeneity among monkey isolates. Thus far, three clonal types have been reported with DNA fingerprinting among isolates from periodontal patients, but additional genetic heterogeneity can be found using specific DNA fragments as probes in hybridization experiments. Intrafamilial transmission ofA. actinomycetemcomitanshas been demonstrated.Porphyromonas (Bacteroides) gingivalisshows extensive genetic heterogeneity and case reports suggest clonal infection of any one individual. In contrast, results with DNA fingerprinting ofEikenella corrodens, Fusobacterium nucleatum, andBacteroides intermediusshow that individuals may be infected with 2 or more clonal types. These studies point to the great potential of DNA fingerprinting for investigating the epidemiology of putative orofacial pathogens. Such studies with periodontal microorganisms will likely reveal steps in the acquisition, intraoral and person‐to‐person transmission, which then could possibly be inhibited or interfered with to prevent periodontal disease or its recurre

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02307.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.This paper summarizes the rationale for the application of microbiology in the management of destructive periodontal diseases. The subgingival microbiota in patients with severe periodontitis is complex and contains high numbers of obligate anaerobic bacteria as well as facultative micro–organisms. It has become clear that major differences exist in the composition of the subgingival microflora. These differences are not only quantitative but also qualitative. Difference in plaque composition is the basis for the application of clinical microbiology in the management of periodontal disease. Several bacterial species have emerged as useful indicators for progressive periodontitis. In this respect, the importance ofActinobacillus actinomycetemcomitans, Bacteroides gingivalisandBacteroides intermediushas been shown in a number of studies. It has become clear thatA. actinomycetemcomitansis not specifically associated with the local form of juvenile periodontitis, but this micro–organism is probably also of importance in severe periodontitis in adult patients. Selection of individuals with anA. actinomycetemcomitansassociated periodontitis is essential since successful treatment in these patients needs an adjunctive antibiotic therapy. Microbiological testing can be useful in patients showing a poor response to periodontal treatment (refractory periodontitis). Factors which may be responsible include poor oral hygiene, poor subgingival debridement, the patient's susceptibility and a subgingival microflora resistant to therapy. In this patient category, microbiological testing is capable of diverting continuing periodontal treatment. Furthermore, microbiology can be useful in evaluating periodontal treatment. Successful elimination of specific periodontopathic microorganisms can be used to determine recall interv

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02308.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Abstract.The microorganisms in periodontitis of special patient categories have been only partially elucidated. The periodontitis microbiota of HIV–infected individuals, cancer patients on myelosuppressive therapy, and persons with other medical disorders includes common suspected periodontal pathogens as well as enteric rods, pseudomonads, staphylococci and yeasts. Failing implants also may be associated with classical periodontal pathogens as well as primarily nonoral potential pathogens. Refractory periodontitis in systemically healthy adults can show a great variety of oral and nonoral organisms. The frequent occurrence of unusual periodontal organisms in special patient categories may be due to a weakened host response and/or usage of various chemotherapeutic regimens. The unusual organisms may contribute to progressive periodontitis and in leukemia patients may even give rise to life–threatening systemic manifestations. The primary therapeutic goal in special periodontitis patients is control of pathogens and amid the wide range of pathogenic microfloras, an effective treatment strategy should include a comprehensive microbiological analysis, especially if systemic antimicrobial therapy is contempla

ISSN:0303-6979    

DOI:10.1111/j.1600-051X.1991.tb02309.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY