epid period.ppt
TRANSCRIPT
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EPIDEMIOLOGI
PENYAKIT PERIODONTAL
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DENTAL EPIDEMIOLOGI :Adalah studi tentang distribusi & dinamika
penyakit gigi pada populasi dalam masyarakat
ental epidemiologi dipengaruhi oleh
Usia - kelamin
Ras/ kelompok - tempat tinggal
pekerjaan - karakter sosial
kerentanan - pemaparan thd agent spesifik
Tujuan :
> Meningkatkan pengertian ttg proses penyakituntuk mencegah dan mengontrol penyakit
period.
> unt mengembangkan cara pengontrolan &
perkembangan penyakit
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INDEKS EPIDEMIOLOGI
Penilaian unt mengkwantisasikan kondisi klinik pada
skala ukuran shg memudahkan dlm memandingkanantara populasi yg diperiksa dg kriteria ! metode yg
sama.
Kriteria Indeks:
mudah digunakandpt digunakan pada populasi dlm waktu singkatdpt menetapkan kondisi klinik seoyek mungkin
dpt digunakan unt menilai keadaan klinik unt satu atau
leih pemeriksamudah dianalisa secara statistikerhu erat secara numerik thd tingkatan keadaan
klinik dr penyakit yg spesifik
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Indeks Periodontal menilai:
". #erajat peradangan gingi$a
%. #erajat kerusakan gingi$a
&. 'anyaknya akumulasi plak
(. 'anyaknya kalkulus
Papillary Marginal ) Attachment *nde+ ,PMA-
*nde+ Periodontal *nde+ ,P* Russel
Periodontal #isease *nde+ ,P#* Ramfjord ingi$al *nde+ ,* oe ! 0illness 1ommunity Periodontal *nde+ of 2reatment 3eeds
,1P*23 dls
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Appearance
Bleeding Inflammation Points
normal no bleeding none 0
slight change in color
and mild edema withslight change in texture
no bleeding mild 1
redness, hypertrophy,
edema and glazing
bleeding on
probing/pressure
moderate
mar!ed redness,hypertrophy, edema,
ulceration
spontaneousbleeding
se"ere #
2he ingi$al *nde+ ,* was de$eloped y oe and 0ilness to
descrie the clinical se$erity of gingi$al inflammation as well
as its location.
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ingi$al *nde+ ,* oe ! 0illnessmenilai keparahan gingivitis
Papilla ,distofacial
Marginal ,facial
Papilla ,mesiofacial
Marginal ,lingual
( 045R*3 U3*2
,( P6RMU4AA3
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ingi$al *ndeks 7 8 skor tiap gigi
(
Arti hasil skor9
0kor : 9 normal
0kor % 9 peradangan ringan 7 sedikit peruahan warna; tdk
ada perdarahan saat palpasi
0kor & 9 peradangan sedang 7 kemerahan; uedem; erkilat;perdarahan pd palpasi
0kor ( 9 peradangan erat 7 kemerahan nyata; odem;
ulcerasi; cenderung
perdarahan spontan
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P6R*5#532A
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Perhitungan skor
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=g digunakan di klinik period.9
Papilla Bleeding Index (PBI)
*ndikator yang sensitif pd peradangan gingi$aUntuk menilai keerhasilan pengukuran/ kegagalan alat
dilangsungkan perawatan periodontalMencatat intensitas peradangan daerah papillaryMemoti$asi pasien ke arah keersihan mulut yg aikProe yg digunakan proe B
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Prosedur klinis P'*
dgn tekanan jari yg ringan dg proe period. tumpul dimasukkan dlm
sulcus
Proe ditegakkan dari dasar papil sampai ke ujungnya sepanjang aspek
mesial ! distal dr gigi
Menimulkan perdarahan
0eluruh kuadran diperiksa %: ) &: dtk
P'* 7 Dumlah 0kor perdarahan papil gingi$a
Dumlah 2otal papil yang diperiksa
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P6R*5#532A *3#6 ,P*
Russell de$eloped an inde+ for measuring periodontal
disease that could e used in population sur$eys. *t
can e ased solely upon the clinical e+amination; or
it can make use of dental -rays if they are a$ailale.
*t places greater emphasis on ad$anced disease.
0coring9
," 6ach tooth is scored separately according to the
following criteria.
,% Rule9 Bhen in dout; assign the lower score.
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$riteria for %ield &tudiesAdditional '()ay $riteria &core
negati"e *neither o"ert inflammation in the
in"esting tissues, nor loss of function due to
destruction of supporting tissues+
radiographic appearance normal 0
mild gingi"itis *o"ert area of inflammation in
the free gingi"ae, but this area does notcircumscribe the tooth+
1
gingi"itis *inflammation completelycircumscribes the tooth, but there is no
apparent brea! in the epithelial attachment+
*not used in field study+ early, notchli!e resorption of the al"eolarcrest
gingi"itis with poc!et formation *the epithelialattachment is bro!en, and there is a poc!et-
.here is no interference with normal
masticatory function, the tooth is firm in its
soc!et, and has not drifted-
horizontal bone loss in"ol"ing the entireal"eolar crest, up to half of the length of
the tooth root *distance from apex to
cemento(enamel unction+
ad"anced destruction with loss of masticatoryfunction *tooth may be loose tooth may ha"e
drifted tooth may sound dull on percussion
with a metallic instrument the tooth may bedepressible in its soc!et+
ad"anced bone loss, in"ol"ing more thanhalf of the length of the tooth root, or a
definite intrabony poc!et with definite
widening of the periodontal membranes-.here may be root resorption, or
rarefaction at the apex
2
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indi$idual score 7
7 AE6RA6 ,scores for all of the teeth in the mouth
population score 7
7 AE6RA6,indi$idual scores in population
e+amined
*nterpretation9
F minimum score9 :
F ma+imum score9 G
F 2he higher the score; the more marked the
periodontal disease.
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The Community Periodontal Index
of Treatment Needs (CPITN)
CPITN is an epidemiologic tool developed
by the World ealth !rgani"ation (W!)
for the evaluation of periodontal disease in
population surveys# It can be used to
recommend the $ind of treatment needed
to prevent periodontal disease#
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2eeth e+amined9 % methods of selection
,"se+tants% &' teeth on the maxilla and &' teeth on the
mandible divided into segments on each
*+I notation maxilla% ,"&, &- &. &'/ ,%& &0 && 0&00 0/ ,&0' 0. 0- 0,
*+I notation mandible% ,(', '- '. ''/ ,H' '0 '&& 0 / ,I' . - ,
third molars are not used unless they function in place ofthe second molars
(0) use of inde+ teeth% . teeth on the maxilla and . teeth on
the mandible
*+I notation maxilla% (&) &, &-/ (0) &&/ () 0- 0, *+I notation mandible% (') ', '-/ (.) &/ (-) - ,
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#ental e$aluation
,"A special proe is used to to e$aluate the depth ofthe dental sulcus.
,% 2he teeth are e+amined for supragingi$al or
sugingi$al calculus.
,& Any leeding after gentle proing is noted.
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Jinding 15#6
pathologic pockets >7 I mm deep :
pathologic pockets (-H mm deep "
supragingi$al or sugingi$alcalculus
%
gingi$al leeding after gentleproing
&
no signs of periodontal disease (
6$aluation
2he worst finding in each se+tant is coded according to
the tale elow.. 2he ma+imum code for the entire mouth is used for the
treatment recommendation.
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Treatment recommendation
ma+imum score :9 no need for additional treatment ma+imum score "9 need to impro$e personal oral
hygiene
ma+imum score %9 need for professional cleaning of
teeth; plus impro$ement in personal oral hygiene ma+imum score &9 need for professional cleaning ofteeth; plus impro$ement in personal oral hygiene
ma+imum score (9 need for more comple+ treatmentto remo$e infected tissue
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E!aluatin" teet#
5nly fully erupted ,occlusal and incisal surface has
reached the occlusal plane permanent teeth are scored.
2hird molars and incompletely erupted teeth are notscored ecause of the wide $ariations in heights of clinical
crowns.
2he uccal and lingual deris scores are oth taken onthe tooth in a segment ha$ing the greatest surface area
co$ered y deris.
2he uccal and lingual calculus scores are oth taken on
the tooth in a segment ha$ing the greatest surface areaco$ered y supragingi$al and sugingi$al calculus.
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3rading 4ebrisPoints
no debris or stain present 0
soft debris co"ering not more than one third of thetooth surface, A54/6) the presence of extrinsicstain without other debris regardless of surface areaco"ered
1
soft debris co"ering more than one third, but notmore than two thirds, of the exposed tooth surface
soft debris co"ering more than two thirds of theexposed tooth surface
#
de$ris index %
7 ,0UM,points along uccal surface for all segments present
0UM,points along lingual surface of all segments present / ,numer of
segments present
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3rading $alculusPoints
no calculus present 0
supragingi"al calculus co"ering not more than one third of the
exposed tooth surface
1
supragingi"al calculus co"ering more than one third but notmore than two thirds of the exposed tooth surface, A54/6)the presence of indi"idual flec!s of subgingi"al calculus aroundthe cer"ical portion of the tooth
supragingi"al calculus co"ering more than two thirds of theexposed tooth surface A54/6) a continuous hea"y band ofsubgingi"al calculus around the cer"ical portion of the tooth
#
calculus index =
1 (234(points along buccal surface for all segments present) 5234(points along lingual surface of all segments present)) 6 (number
of segments present)
oral hygiene index =1 (debris index) 5 (calculus index)
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Parameter(indin" S)ore
gingival score
negati"e 0
mild gingi"itis in"ol"ing the free gingi"a *margin,
papilla, or both+
1
moderate gingi"itis in"ol"ing both free and attachedgingi"a
se"ere gngi"itis with hypertrophy and easy hemorrhage #
bone score
no bone loss 0
incipient bone loss or notching of al"eolar crest 1bone loss about one fourth of root length, or poc!etformation one side not o"er one half of root length
bone loss about one half of root length, or poc!etformation one side not o"er three fourth root lengthmobility slight
#
bone loss about three 7uarters of root length, or poc!etformation one side to apex mobility moderate
bone loss complete mobility mar!ed 8
#
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gingial !one score1
7 0UM,,gingi$al score ,one score / ,numer of teeth e+amined
7 ,mean gingi$al score ,mean one score
In"er#re"a"ion
minimum score9 : ma+imum score9 G 2he higher the score; the more serious the
periodontal disease.
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The Sulcus Bleeding Index (SBI)
can e used to assess a patient for gingi$itis; which can e important in the
pre$ention of periodontal disease. 2his was initially called the LPM *nde+L;
ut the name was changed to pre$ent confusion with the LPMA *nde+L.
3umer of teeth e+amined9 "I ,the anterior ( in each ?uadrant; % on ma+illa
and % on mandile
2eeth in each ?uadrant
," medial incisor
,% lateral incisor,& cuspid
,( first premolar
0urfaces on each tooth proed9 (
," M laial
,% M lingual
,& P mesial
,( P distal
2otal numer of readings9 I(
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Periodontal Index of Russell
Russell de$eloped an inde+ for measuring periodontaldisease that could e used in population sur$eys. *t can
e ased solely upon the clinical e+amination; or it can
make use of dental -rays if they are a$ailale. *t places
greater emphasis on ad$anced disease.
Scoring:
," 6ach tooth is scored separately according to the
following criteria.
,% Rule9 Bhen in dout; assign the lower score.
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$riteria for %ield &tudiesAdditional '()ay $riteria &core
negati"e *neither o"ert inflammation in the
in"esting tissues, nor loss of function due to
destruction of supporting tissues+
radiographic appearance normal 0
mild gingi"itis *o"ert area of inflammation in the
free gingi"ae, but this area does not circumscribethe tooth+
1
gingi"itis *inflammation completely circumscribesthe tooth, but there is no apparent brea! in the
epithelial attachment+
*not used in field study+ early, notchli!e resorption of the al"eolar crest
gingi"itis with poc!et formation *the epithelial
attachment is bro!en, and there is a poc!et- .hereis no interference with normal masticatory
function, the tooth is firm in its soc!et, and has not
drifted-
horizontal bone loss in"ol"ing the entire al"eolar
crest, up to half of the length of the tooth root*distance from apex to cemento(enamel
unction+
ad"anced destruction with loss of masticatory
function *tooth may be loose tooth may ha"edrifted tooth may sound dull on percussion with a
metallic instrument the tooth may be depressible
in its soc!et+
ad"anced bone loss, in"ol"ing more than half of
the length of the tooth root, or a definiteintrabony poc!et with definite widening of the
periodontal membranes- .here may be root
resoprtion, or rarefaction at the apex
2
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individual score7
7 RA2A% ,scores for all of the teeth in the mouth
population score =
7 RA2A% ,indi$idual scores in population e+amined
Interpretation:
minimum score9 : ma+imum score9 G 2he higher the score; the more marked the periodontal disease