application of community periodontal index in nigeria

8/7/2019 Application of Community Periodontal Index in Nigeria

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Six teeth were examined, each representing a sextantsince the students are below 20 years. (1)(11).

TABLE 1

Codes Periodontal Condition

0 No bleeding

No calculus

No pathological pocket

1 Bleeding on probing gingival margin

No calculusNo pathological pocket

2 Presence of calculus (sub ou supra

gingival) with or without bleedingNo pathological pocket

3 Pathological pocket of 4-5 mm with or

without bleeding and calculus

4 Pathological pocket of 6 mm or morewith or without bleeding and calculus

A questionnaire designed to know the age, sex, socio-economic background, method (principal) of oral

hygiene and attitude towards oral health of the studentswas administred before the clinical periodontalexamination : the h ighest C.P. I . T.N in each sextantafter examination of the four sites (labial, lingual/ palatal, mesical and distal) was retained as the score

for the sextant : The average score for each subjectwas calculated.All examinations were conducted within the samemonth.

RESULTS

Table II : Classification according

to age groups/sex

Age 12-12 14-15 16-18 Total

Sex

Males 63,4% 41% 70% 56,4%52 57 77 186

Females 36,5% 59% 30% 43,6%30 81 33 144

Total 100% 100% 100% 100%

82 138 110 330

APPLICATION OF COMMUNITY PERIODONTAL INDEX OF

TREATMENT NEED (CPITN) IN ENUGU (NIGERIA) :

STUDY OF SECONDARY SCHOOL STUDENTS AGED BETWEEN 12-18 YEARS

S. MADUAKOR*, Y. LAUVERJAT**, S. CADOT***, R. DA COSTA NOBLE**, C. LAPORTE, AND JL. MIQUEL***

*Dentistry Department University of Nigeria - NSUKKA - NIGERIA.

** Department of Periodontology - Bordeaux II University FRANCE.*** Department of Epidemiology and Public Health - Bordeaux II

University FRANCE.

INTRODUCTION

A significant prevalent of periodontal disease hasbeen established in Nigeria by several authors (2)(3).This prevalence varies from one region to another

(8)(14), also from different socio-economic and agegroups (7)(9)(18).In this study involving 330 secondary school students

aged between 12-18 yeats in Enugu, East of Nigeria,attempt is made at identifying their periodontaltreatment needs with the intention of knowing themeasures necessary to ensure a good periodontalhealth now and in the future. Account is taken of the

fact that there are two major methods of oral hygienepraticed by the population :- tooth brush and tooth paste,

- chewing sticks.

It is known that a good percentage of Nigerians, infact, Africans, use the chewing stick as their principal

methods of oral hygiene. (4)(16)(21) Sote E.O.

MATERIALS AND METHODS

A total of 330 students were studied.

4 secondary schools were selected for the study :

. 2 special secondary schools (for the privileged).One for boys and the other girls.

. 2 ordinary secondary schools (public). One forboys and the other for girls.

In each school, an average of 82 students werestudied :

. 41 junior students (J.S.2)

. 41 senior students (S.S.2).

With the co-operation of the principals of therespective schools, the students were not informed of

the proposed exercise to avoid any modifications ofthe situations of oral health : students presenting withchronique medical conditions (sickle-cell anaemia,Epilepsy and diabetes) were excluded.



Application of community…

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The question in view is to determine which principal

method of oral hygiene is practiced : tooth brush/

paste or chewing stick.

80 % of the students use tooth brush/paste against

20% who use chewing stick : this tendency holds for

the 3 age groups.The population is distributed in

3 age groups / -the 12-13 years representing 25% ;

the 16_18 years, 33% and the 14-15 years, 42% : In

general, among the 330 students examined, the boys

are more numbrous than the girls (56,40% against

43,60%). This relation varies from one age groups to

another : -the boys remain on majority in the age-

groups 12-13 years and 16-18 years (60,40% and

70% respectively) where as in the age group 14-15

years, the girls from the majority.

The question in view is to determine which principal

method of oral hygiene is practiced : tooth brush/

paste or chewing stick.

80% of the students use tooth brush/paste against

20% who use chewing stick : this tendency holds for

the 3 age groups.

Table III : classification according

to age groupes and method of oral hygiene

Age 12-13 14-15 16-18 Total

Method of

oral hygiene

Brush Toothpaste 77% 80% 82% 80%

63 111 90 264

Chewing stick 23% 20% 18% 20%

29 27 20 66

Total 100% 100% 100% 100%

82 138 110 330

Odonto-Stomatologie Tropicale

Table IV : The prevalence of periodontal disease condition / group of age

CPITN 0 1 2 3 4 TOTAL

Group of age

12-13 yrs 19,5% 63,4% 17,1% 0% 0% 100%82 16 52 14 0 0 82

14-15 yrs 12,3% 60,8% 26,1% 0,72% 0% 100%

138 17 84 36 1 0 138

16-18 yrs 3,6% 44,6% 50,9% 0,9% 100%110 4 49 56 1 0 110

Total 100% 11,8% 56,3% 31,4% 0,54% 0330 37 185 106 2 0 330

In general, more than half of the population (56,30%)present with bleeding (Code I) ; a third (31,40%),calculus (Code 2) and only 2 students present withperiodontal pocket of 4-5mm (Code 3). A prepon-derance of bleeding on probing is observed amongthe age group 12-13 years (63,40% ) as well as in theage group 14-15 years (60,80% ). There is a

diminution of bleeding in group 16-18 years (44,60%)

giving way to calculus which accounts for 50,90%.With advancing of age, there is decreasing “absenceof disease” (Code 0) : - 19,5% for age group 12-13years ; 12,3% for the 14-15 years and only 3,6% forthe 16-18 years.The corollary is that as the population grows oldernthe more the intensity of periodontal diseases, tensity

of periodontal diseases.Table V : the prevalence of periodontal disease in relation to oral hygienemethod

CPITN 0 1 2 3 4

Oral hygiene Method

Tooth Brush/Paste 12,4% 56,1% 31,8% 0,4% 0%264 32 148 84 1 0

Chewing stick 10,6% 56,1% 33,3% 1,5% 0%

66 7 37 22 1 0

Total 11,4% 56,1% 32,5% 0,9% 0%330 37 185 106 2 0

Treatment No treatment Motivation Motivation Complex treatment Complex treatment+ Scaling polishing




31

One does not see a significant difference between the

students using either of the methods of Oral Hygiene :

Nevertheless, there is slight advantage for the use of

tooth brush/paste (31,8% against 33,3% (Code 2).


Table VI : the severity of periodontal disease in relation to the age groups

CPITN CPITN CPITN CPITN CPITN

Age Population 0 1 2 3 4

12-13 yrs 82 2,79 1,28 1,88 0,00 0,00

14-15 yrs 138 2,29 1,18 2,32 0,04 0,01

16-18 110 1,39 1,28 3,15 0,01 0,02

Total 330 49 2,16 1,25 2,45 0,02 0,01

The severity or the average number of sextantsa ffected for each student augment with age.Generally this population presents 2,45 sextants withproblem of calculus and has a tendency of increasingseverity as the age advances : 1,88 sextants for the12-13 years ; 2,32 sextants for the 14-15 years groupand 3,15 sextants for the 16-18 years.In the same manner the population presents 2,16

sextants without periodontal disease (Code 0) andthere is decreasing - order tendency for the agegroups : - 2,79 sextants for the 12-13 years ; 2,29sextants for the 14-15 years and 1,39 sextants for the16-18 years.The severity of bleeding (Code I) remains stable in allthe age-groups with an average of 1,95 sextantseffected,

Table VII : treatment needs

Age Nb of cases Motivation Scaling and polishing Complex treatment No need for treatment

12-13 yrs 24,9% 63,4% 17,1% 0% 19,5%

82 52 14 0 1614-15 yrs 41,8% 60,8% 26,1% 0,72% 12,3%

138 84 36 1 17

16-18 yrs 33,3% 44,6% 50,9% 0,9% 3,6%110 49 56 1 4

Total 100% 56,3 31,4% 0,54% 11,8%330 185 106 2 37

More than hal f of the populat ion 56,3% neededucation on oral hygiene measures (motivation).Just 1/3 (31,4%) need scaling and polishing. Only 2children out of 30 need complex treatment. 55% of

those needing scaling and polishing and from the agegroup 16-18 years. 45% of those needing motivationare from the age group 14-15 years. 2/3 of studentsaged between 12-15 years and almost 1/2 of thoseaged between 16-18 years need motivation. Again 1/2of the 16-18 years need scaling and polishing ; 1/4 ofthe 14-15 years and only 1/5 of the 12-13 years needthe same scaling and polishing.20% of the students aged between 12-13 years donot have need for any treatment where as all thestudents aged between 16-18 years except 4, needperiodontal treatment.

The need for treatment increases with age.

DISCUSSION

In this study, one notes an augmentation of theprevalence and severity of periodontal pathology with

increasing age. This is in conformity with the result ofvarious publications (15) in Nigeria, (14) Ta n z a n i a ,(12) Sierra)Leone and (16) Zaire.Inspite of the high prevalence of bleeding (code 1),the severity is remarkably low (1,25 sextants out ofsix). There is only a case of juvenile periodontitis(0,3%) which confirms the figure of 0,3% - 0,7% givenfor Nigeria / Thailand (18) and other studies on theblack-race : (6) (9) which give the figures of between0,1 and 0,5%.The treatment need of this population is generallycovered by motivation and scaling / polishing. In a

population where the rate of clinical consultation is




32

abysmally low 27% (5% only having ever had scaling / polishing) the necessity for the moblilisation ofe fforts towards information and education on oral

health and oral hygiene measures become veryimportant.

Concerning the method of oral hygiene, there is astriking shift from the use of chewing stick to the useof brush and tooth paste with advancing age. Thistrend is completely in keeping with the observationswhich link the choice and use of tooth brush / toothpaste with increasing self-esteem (16) (13).

The tooth brush / kpaste shows a slight advantageover chewing stick. If at this tender age group (12-18

years) there is already a difference, the advantagewill be more pronounced later in life. The chewing

stick however, can be a good method of oral hygieneas documented for Nigeria (21) ; Ethiopia (17) an

Kenya (5).

The tendency where by the tooth brush / paste isseen as a status-symbol (evidence of modernisation)should be disabused. Most of those who use thetooth brush / paste do not know how to use them and

sometimes do not have the financial means tochange them as and when due, or even to procurethe tooth paste. The consequence is far-reaching.

The World Health Organisation should give herweight on the campaign for the correct use of the very

available and cheap chewing stick. If the oral healthfor all by the year 2000 is to be a reality, the correct

uses of tooth brush / paste and the chewing sticksshould be simultaneously encouraged.


BIBLIOGRAPHIE

1. J. AINAMO, D.BARMES, G.BEAGRIE, T. CUTRESS, J.MARTIN, AND SARDO INFIRI

Development of World Health Organisation CPITN. 1982,International Dental Journal, n°32, p.28-91

2. SP. AKPABIO

Public health service in East and West Africa. 1966, Dental

Practioners and dental record, n°16, p.412-21.

3. ANA J,R AND V. KUMAR.Prevalence and severity of periodontal in adult Nigerians. 1980,

Nigerian Dental Journal, n°1, p.7-15.

4. J. COYOTTEPratique et thérapeutique odontostomatologie en Afrique Noire.

Thèse pour Docteur en Chirurgie Dentaire. 1977.Aix Marseille Université.

5. B. DANIELSSON, V. ET AL. BAELUM.Chewing sticks, toothbrush and plaque removal. 1989.

Acta ondotologica Scandinavia. n°47, p.12-125.

6. JB. ET AL, EMSLIEA dental health survey in the republic of Sudan. 1968.

British dental journal, n°120, p. 167-178.

7. C.O. ENWONWU & J.C. EDOZIEM

Epidemiology of periodontal diseases in Western Nigerians in

relation to socio-economic status. 1970. n°15, p. 1231-12448. N.E HENSHAW AND J.O. ADENUBI

Periodontal diseases in the Northern zone of Nigeria. 1975.

Nigerian Medical Journal, n°4, p.185-196.

9. HIRSHFIELD AND B, WASSERMANA long-term survey of tooth loss in 600 trealted periodontal patients.1978.

Journal of Periodontology, n°49, p.225-237.

10. S.O JEBODA

Periodontal tooth mortality in permanent dentition of Nigerian

atteding a private clinic il Lagos Metropolis. 1988.Odontostomatology tropical, n°XV (3) , p. 19-24.

11. J. LINDHE

Epidemiology of periodontal diseases.

Manuel of clinical periodontology, p. 58-63.

12. L.J. MABELYA, FRENEKEN ET COL.

Dental caries, plaque, calculus and gingival bleeding in 14-17 years

old secondary school scholars in Tanzania. 1989.

Odontostomatology tropical, n°XVI (3), p. 4-9.

13. I.D.M. MAC GREGOR

Self-esteem as a predictor of tooth brushing behaviour in yound

asolescents. 1990.

Journal of clinical periodontology, n°18, p. 312-316.

14. I.D.M. MAC GREGOR & A. SHEIHAM

Pattern of periodontal pocketing in western Nigerian population.

1974.

Journal of periodontal, n°45, p. 402-409.15. T. MAVUEMBA, Y. SANGWAY, K. TUKUTUKU

Applicaiton de l’index communautaire des besoins en traitments

parodontaux aux cliniques universitaires de Kinshasha. 1991.

Odontostomatologie tropical, n°XIV (4), p. 9-13.

16. O. MELVILLE, GEORGE

Towards better oral health using traditional methods. 1988.

Odontostomatology tropical, n°XI (2), p. 70-73.

17. B. OLSSON

E fficiency of traditional chewing sticks in oral hgiene programs

among Ethiopian school children. 1978.

Community dentistry and oral Epidemiology, n°6, p. 105-295.

18. A.L. RUSSELL

The prevalence of periodontal diseases in different population

during circumpubertal period. 1971.

Journal of periodontology, n°42, p.508-512.19. L. SAXEN

Prevalence of juvenile periodontitis in Finland. 1980.

Journal of clinical periodontology, n°7, p. 177-186.

20. A. SHEIHAM & JEBODA

Periodontal disease in Nigeria : the problem and possible solutions.

1981.

Odontostomatology tropical, n°4, p. 211-219.

21. E.O. SOTE

The relative effectiveness of chewing stick and tooth brush on

plaque removal. 1987.

African dental journal, n°1, p. 48-53.

application of community periodontal index in nigeria

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