On-line version ISSN 1678-4464
Print version ISSN 0102-311X
Cad. Saúde Pública vol.13 n.2 Rio de Janeiro Apr. 1997
NOTA RESEARCH NOTE
|Ercilia Leal Dini1 |
Ana Lígia Rozato Foschini2
Ioneide Maria Gomes Brandão2
|Periodontal conditions in a 7-19-year-old student population in Araraquara, São Paulo, Brazil, 1995 |
Condições periodontais em população de estudantes com idades de 7-19 anos em Araraquara, São Paulo, Brasil, 1995
|1Departamento de Odontologia Social, Faculdade de Odontologia de Araraquara, Universidade Estadual Paulista C. P. 331, Araraquara, SP 14801-903, Brasil. |
2Secretaria Municipal de Saúde, Prefeitura Municipal de Araraquara. Rua São Bento 840, Araraquara, SP 14801-901, Brasil.
|Abstract The Purpose of this study was to assess the periodontal conditions and treatment needs in 7-19-year-old Brazilian school children and adolescents enrolled in the urban public schools in Araraquara, São Paulo, Brazil, in 1995, to provide baseline data for monitoring changes in their periodontal status. A sample of 1,956 school children and adolescents aged 7 to 19 years was examined by two examiners previously calibrated using the CPITN (Community Pe riodontal Index of Treatment Needs). The results showed that bleeding was the most frequently observed periodontal condition in all age groups, with a mean of 3.0 sextants affected at age 15. The presence of calculus increased with age. In the 15-19-year age group, calculus and shallow pockets (3.5-5.5 mm) were observed in 39.8 per cent and 1.6 per cent of the adolescents, respectively. In order to achieve the WHO oral health goal of no more than one sextant scoring GPITN 1 (bleeding) or 2 (presence of dental calculus) at age 15, priority should be focused on primary prevention programs to benefit the periodontal health of the majority. |
Key words Community Dentistry; Epidemiology; Dental Health Services; Periodontal Diseases; Public Health
Resumo O objetivo deste estudo foi verificar as condições periodontais e necessidades de tratamento em crianças e adolescentes, com idades entre 7 e 19 anos, matriculados em Escolas Públicas de Araraquara, SP, Brasil, em 1995, com o propósito de se obter um banco de dados-base inicial para o monitoramento das mudanças no estado periodontal. Uma amostra de 1956 crianças e adolescentes foi examinada por duas examinadoras, previamente calibradas, usando o CPITN. Os resultados mostraram que o sangramento gengival foi a condição periodontal mais frequentemente observada em todas as idades, com média de 3,0 sextantes afetados na idade de 15 anos. A presença de cálculo dental aumentou com a idade. No grupo etário de 15-19 anos, o cálculo dental e as bolsas periodontais rasas (3,5-5,5 mm) foram observados em 39,8% e 1,6% dos adolescentes, respectivamente. Com o propósito de alcançar a meta da OMS de não mais do que um sextante com escores 1 (sangramento) ou 2 (presença de cálculo dental) do CPITN na idade de 15 anos, prioridade deve ser dada aos programas de prevenção primária para que a saúde periodontal da maioria seja beneficiada.
Worldwide acceptance of the CPITN (Community Periodontal Index of Treatment Needs) (Cutress et al., 1987) for assessing periodontal conditions and treatment needs at the community level and the overview CPITN data for key age groups that have been published by the WHO Global Oral Data Bank in the last ten years have provided an important outlook on the magnitude of periodontal disease around the world (Pilot et al.,1986; Pilot & Barmes, 1987; Pilot et al.,1987; Miyazaki et al.,1991; Miyazaki et al.,1992; Pilot & Miyazaki,1994). This has provided the basis for WHO periodontal health goals for the year 2000 (Barmes & Leous, 1986).
The CPITN has proven to be an useful tool for planning periodontal treatment needs, establishing population periodontal health goals, and evaluating changes in the periodontal status of a given population after a program implementation.
The purpose of this study is to assess periodontal conditions and treatment needs in 7- 19-year-old school children and adolescents from Araraquara, São Paulo, Brazil in 1 995, to provide baseline data for monitoring changes in their periodontal status.
Material and methods
The study population consisted of 27,259 7-19-year-old school children and adolescents enrolled in all urban public schools in Araraquara, São Paulo, Brazil, in 1995.
The sample size was defined according to Silva (Silva, 1968). The level of significance was established at 5 per cent and the level of precision at 0.4 (WHO, 1987). The variances used were those obtained in the 1989 epidemiological dental survey carried out in the student population in Araraquara (Dini et al., 1996). From the class lists of the 34 urban public schools, previously ordered by age and using systematic random sampling procedure (Kahn & Sempos, 1989), 1,956 individuals aged 7-19 years were selected. Two previously calibrated examiners (ELD; IMGB) carried out the examinations in the dental chairs of the schools, using artificial lighting and WHO periodontal probes. Records were made by trained assistants.
The CPITN (Community Periodontal Index of Treatment Needs) was used to assess periodontal conditions, based on WHO criteria and registers (Cutress et al., 1987; WHO, 1987), utilizing six index teeth (teeth 16,11,26,36,31,46) to represent the six sextants of the mouth. For individuals under 15 years old, examination of the six teeth included scoring for bleeding and calculus. The data was compiled using the WHO special software.
Preliminary results showed no differences in periodontal conditions between the sexes; the results were thus combined.
Table 1 shows the number of subjects examined and the percentage distribution according to the highest CPITN score and age. Table 2 shows the mean number of sextants affected per person, according to age. Table 3 shows the percentage of subjects by number of healthy sextants, according to age.
Results showed that bleeding was the most frequently observed periodontal condition in all age groups (Table 1). The presence of calculus increased with age and was observed in 39.8 per cent of 15-19-year-old subjects. In addition, only 1.6 per cent of the subjects in this age group showed shallow pockets (3.5-5.5 mm) (Table 1).
The mean number of healthy sextants ranged from 2.9 in 11-year-olds to 3.6 in 7 year-olds (Table 2). At age 15, the mean number of healthy sextants was 3.0. The mean number of sextants with calculus increased with age and appeared in approximately one sextant of the 15-19-year-old subjects (Table 2).
The results also showed that a small percentage of subjects had no healthy sextants (Table 3). The greatest percentage of subjects (ranging from 61.8 per cent in 7-year-olds to 75.9 per cent in 12-year-olds) showed 1-4 healthy sextants (Table 3). The percentage of subjects showing only one or no sextant affected ranged from 18.7 per cent in 15-year-olds to 35.6 per cent in 7-year-olds (Table 3).
The results of this survey indicated that the majority of subjects in all ages are in need of oral hygiene instructions, as bleeding was the most frequently observed periodontal condition. The present findings for calculus and shallow pockets (3.5-5.5 mm) in the 15-19 year age group are comparable to those found in several developing and developed market-economy countries, as published by the WHO (Miyazaki et al., 1992).
The prevalence of calculus and thus the need for scaling in the 15-19 year age group (39.8 per cent) is similar to that found for the Brazilian urban population of the same age in 1986 (42 per cent) (Miyazaki et al., 1992). However, periodontal conditions in this IS-19-year-old student population are better than those observed in workers of the same age group in Araraquara, São Paulo, Brazil, in 1994 (Dini & Guimarães, 1994). In addition, results of the present investigation also showed better periodontal conditions than those observed in 15-19-year-old subjects from the city of Rio de Janeiro in 1988 (Flores de Jacoby et al., 1991).
In Araraquara, school children up to age 12 are the priority target population in the municipal dental prevention/treatment program, implemented in public schools in 1989. As part of the program, sessions of oral hygiene instructions are performed by professionals (dentists or trained assistants) every three months, with distribution of fluoridated toothpaste and toothbrushes to all the children involved in the program.
Lack of baseline data on periodontal condi tions in this population makes it impossible to evaluate the effectiveness of the implemented program. As stated by Gjermo (Gjermo, 1991; 1994), monitoring treatment results should always relate to the goals for the treatment, in order to be of value for health planners at the community level.
Goals for oral health for the year 2000 have been proposed by the FDI and WHO (Fédération Dentaire Internationale, 1982). The suggested periodontal health goal for the 12-18 year age group is no more than three sextants affected (Barmes & Leous, 1986). Recently, during the 4th World Congress on Preventive Dentistry, held in Umcå, Sweden, in September, 1993, the WHO proposed the global goals for the year 2010, with a periodontal health goal for adolescents of no more than one sextant scoring CPITN 1 or 2 at the age 15.
Results of the present study showed that the percentage of subjects aged 15 with three or more healthy sextants was 61.3 per cent, while only 18.7 per cent of them showed one or no sextant affected (Table 3). The majority of individuals at this age (74.6 per cent) showed 1-4 sextants affected by bleeding and/or calculus, while only 6.7 per cent of the 15-year-olds showed all sextants affected (Table 3).
According to Gjermo (Gjermo, 1991), "the term need for treatment should be defined as the necessary intervention to change the existing condition into the one described as the goal". For this study population, considering its periodontal status and all the available resources, it appears possible to have one hundred per cent of 15-year-olds showing three or more healthy sextants by the year 2000 and all of them with no more than one sextant scoring CPITN 1 or 2 by the year 2010.
Taking into account that only 35.6 per cent of 7-year-old school children showed 5-6 healthy sextants (Table 3), efforts should be made for the ongoing implementation of oral hygiene instruction sessions with the target population (7-12 years-old) and, if possible, extending them up to the age 15. Improvement of oral hygiene measures for these children and adolescents aims at the ultimate goal, which is the maintenance of a healthy, naturaily functioning dentition throughout their lifetime.
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